Provider Demographics
NPI:1417527656
Name:360 PRIME CARE
Entity Type:Organization
Organization Name:360 PRIME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMASON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-484-8891
Mailing Address - Street 1:47028 BEN FRANKLIN DR
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48315-4604
Mailing Address - Country:US
Mailing Address - Phone:586-484-8891
Mailing Address - Fax:586-323-1130
Practice Address - Street 1:47028 BEN FRANKLIN DR
Practice Address - Street 2:
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48315-4604
Practice Address - Country:US
Practice Address - Phone:586-484-8891
Practice Address - Fax:586-323-1130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-29
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173C00000XOther Service ProvidersReflexologistGroup - Single Specialty