Provider Demographics
NPI:1659146587
Name:PRIMECARE PSYCHIATRIC SERVICES LLC
Entity Type:Organization
Organization Name:PRIMECARE PSYCHIATRIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CRNP
Authorized Official - Prefix:
Authorized Official - First Name:TESSY
Authorized Official - Middle Name:
Authorized Official - Last Name:ALOZIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-513-3935
Mailing Address - Street 1:122 W LANCASTER AVE
Mailing Address - Street 2:STE 01
Mailing Address - City:SHILLINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19607-1956
Mailing Address - Country:US
Mailing Address - Phone:484-513-3935
Mailing Address - Fax:484-513-3931
Practice Address - Street 1:122 W LANCASTER AVE
Practice Address - Street 2:STE 01
Practice Address - City:SHILLINGTON
Practice Address - State:PA
Practice Address - Zip Code:19607-1956
Practice Address - Country:US
Practice Address - Phone:484-513-3935
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-21
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103797513Medicaid