Provider Demographics
NPI:1366816472
Name:PRIVACARE LLC
Entity Type:Organization
Organization Name:PRIVACARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:937-631-4008
Mailing Address - Street 1:1526 UPLANDS DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45506-4025
Mailing Address - Country:US
Mailing Address - Phone:937-631-4008
Mailing Address - Fax:937-398-8902
Practice Address - Street 1:1526 UPLANDS DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45506-4025
Practice Address - Country:US
Practice Address - Phone:937-631-4008
Practice Address - Fax:937-398-8902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-30
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty