Provider Demographics
NPI:1245766310
Name:PRIME PSYCHIATRIC CARE, LLC
Entity Type:Organization
Organization Name:PRIME PSYCHIATRIC CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:J
Authorized Official - Last Name:GOISSE
Authorized Official - Suffix:
Authorized Official - Credentials:MSN
Authorized Official - Phone:412-274-0303
Mailing Address - Street 1:PO BOX 57430
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20037-0430
Mailing Address - Country:US
Mailing Address - Phone:412-412-0303
Mailing Address - Fax:412-802-9156
Practice Address - Street 1:6245 LIVING PLACE
Practice Address - Street 2:SUITE 2085
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15206
Practice Address - Country:US
Practice Address - Phone:412-274-0303
Practice Address - Fax:412-802-9156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-10
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP014433261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health