Provider Demographics
NPI:1346694346
Name:PRIME CARE HEALTH SERVICES INC
Entity Type:Organization
Organization Name:PRIME CARE HEALTH SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:AUGUSTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHIDEBE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-418-5391
Mailing Address - Street 1:451 E CARSON PLAZA DR STE 101
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90746-3210
Mailing Address - Country:US
Mailing Address - Phone:424-558-3846
Mailing Address - Fax:310-381-0039
Practice Address - Street 1:451 E CARSON PLAZA DR STE 101
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90746-3210
Practice Address - Country:US
Practice Address - Phone:310-418-5391
Practice Address - Fax:310-381-0039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-16
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251E00000X
251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health