Provider Demographics
NPI:1326381401
Name:PRIME CARE SERVICES INCORPORATED
Entity Type:Organization
Organization Name:PRIME CARE SERVICES INCORPORATED
Other - Org Name:PRIME HOME CARE INCORPORATED
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ADMINISTRATOR
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 206
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:
Mailing Address - Fax:
Practice Address - Street 1:2306 OAK LN STE 206
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:214-418-8240
Practice Address - Fax:972-262-6544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-27
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty