Provider Demographics
NPI:1477556751
Name:PRIME CARE HEALTH AGENCY, INC
Entity Type:Organization
Organization Name:PRIME CARE HEALTH AGENCY, INC
Other - Org Name:PRINCIPLE HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIECO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:305-591-7774
Mailing Address - Street 1:11440 N KENDALL DR STE 500
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-1025
Mailing Address - Country:US
Mailing Address - Phone:305-591-7774
Mailing Address - Fax:305-594-8951
Practice Address - Street 1:11440 N KENDALL DR STE 500
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-1025
Practice Address - Country:US
Practice Address - Phone:305-591-7774
Practice Address - Fax:305-594-8951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-31
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHHA20960096251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL027021103Medicaid
FL678246900Medicaid
FLJO6OtherBCBS
FL027021100Medicaid
FL027021196Medicaid
FL027021101Medicaid