Provider Demographics
NPI:1497386072
Name:PRIME CARE WORLD
Entity Type:Organization
Organization Name:PRIME CARE WORLD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:GLOTOV SHTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-668-3228
Mailing Address - Street 1:110 S MARY AVE
Mailing Address - Street 2:STE 2/131
Mailing Address - City:NIPOMO
Mailing Address - State:CA
Mailing Address - Zip Code:93444
Mailing Address - Country:US
Mailing Address - Phone:805-668-3228
Mailing Address - Fax:
Practice Address - Street 1:188 W TEFFT ST UNIT B
Practice Address - Street 2:
Practice Address - City:NIPOMO
Practice Address - State:CA
Practice Address - Zip Code:93444-9669
Practice Address - Country:US
Practice Address - Phone:805-668-3228
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-31
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based