Provider Demographics
NPI:1164648069
Name:PRIMECARE ADVANTAGE LLC
Entity Type:Organization
Organization Name:PRIMECARE ADVANTAGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:M
Authorized Official - Last Name:HAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-292-6393
Mailing Address - Street 1:141 NW 35TH CT
Mailing Address - Street 2:
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33309-5209
Mailing Address - Country:US
Mailing Address - Phone:954-567-0665
Mailing Address - Fax:954-567-0665
Practice Address - Street 1:141 NW 35TH CT
Practice Address - Street 2:
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33309-5209
Practice Address - Country:US
Practice Address - Phone:954-567-0665
Practice Address - Fax:954-567-0665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities