Provider Demographics
NPI:1609128826
Name:PRIME CARE INC MAT-SU
Entity Type:Organization
Organization Name:PRIME CARE INC MAT-SU
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GANIYU
Authorized Official - Middle Name:
Authorized Official - Last Name:SHITTU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-727-4090
Mailing Address - Street 1:PO BOX 211706
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99521-1706
Mailing Address - Country:US
Mailing Address - Phone:907-727-4090
Mailing Address - Fax:
Practice Address - Street 1:701 E PARKS HWY STE 207
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-8164
Practice Address - Country:US
Practice Address - Phone:907-727-4090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRIME CARE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-10-11
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health