Provider Demographics
NPI:1639429780
Name:PRIMARY CARE SERVICES, INC.
Entity Type:Organization
Organization Name:PRIMARY CARE SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:WOJCIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-417-7901
Mailing Address - Street 1:2290 NW 2ND AVE
Mailing Address - Street 2:SUITE 6
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-7457
Mailing Address - Country:US
Mailing Address - Phone:561-417-7901
Mailing Address - Fax:561-417-7977
Practice Address - Street 1:2290 NW 2ND AVE
Practice Address - Street 2:SUITE 6
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-7457
Practice Address - Country:US
Practice Address - Phone:561-417-7901
Practice Address - Fax:561-417-7977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-17
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL29991460251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL29991460OtherHOME HEALTH AGENCY NON CERTIFIED LICENSE #
FL1249OtherHEALTH CARE SERVICES POOL