Provider Demographics
NPI:1689044745
Name:PRIVE CARE, INC.
Entity Type:Organization
Organization Name:PRIVE CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DMITRY
Authorized Official - Middle Name:
Authorized Official - Last Name:UCHITEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-974-4080
Mailing Address - Street 1:19500 NORMANDIE AVE STE B
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90502-1108
Mailing Address - Country:US
Mailing Address - Phone:310-974-4080
Mailing Address - Fax:877-742-0658
Practice Address - Street 1:19500 NORMANDIE AVE STE B
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90502
Practice Address - Country:US
Practice Address - Phone:310-974-4080
Practice Address - Fax:877-742-0658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-01
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550003235251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA550003235OtherCDPH