Provider Demographics
NPI:1154099117
Name:PRIME CARE ATTENDANT SERVICES INCORPORATED
Entity Type:Organization
Organization Name:PRIME CARE ATTENDANT SERVICES INCORPORATED
Other - Org Name:PRIME CARE ATTENDANT SERVICES INCORPORATED
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:EDOLO
Authorized Official - Middle Name:
Authorized Official - Last Name:AZENABOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-418-8240
Mailing Address - Street 1:2306 OAK LN STE 202
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75051-8270
Mailing Address - Country:US
Mailing Address - Phone:972-447-7530
Mailing Address - Fax:972-447-7529
Practice Address - Street 1:2306 OAK LN STE 202
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75051-8270
Practice Address - Country:US
Practice Address - Phone:972-642-2400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-02
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health