Provider Demographics
NPI:1518570860
Name:PRIME CARE CONSULTANTS LLC
Entity Type:Organization
Organization Name:PRIME CARE CONSULTANTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:L
Authorized Official - Last Name:WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-453-1180
Mailing Address - Street 1:3707 VIRGINIA BEACH BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-3412
Mailing Address - Country:US
Mailing Address - Phone:757-453-1180
Mailing Address - Fax:757-453-1187
Practice Address - Street 1:3707 VIRGINIA BEACH BLVD STE 202
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-3412
Practice Address - Country:US
Practice Address - Phone:757-453-1180
Practice Address - Fax:757-453-1187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-26
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
No385H00000XRespite Care FacilityRespite Care