Provider Demographics
NPI:1699374934
Name:PRIMARY HEALTH CARE RESOURCE SERVICE, LP
Entity Type:Organization
Organization Name:PRIMARY HEALTH CARE RESOURCE SERVICE, LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NASRA
Authorized Official - Middle Name:MOHAMED
Authorized Official - Last Name:MIRREH
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:404-287-5406
Mailing Address - Street 1:5405 MEMORIAL DR STE 101
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30083-3234
Mailing Address - Country:US
Mailing Address - Phone:404-287-5406
Mailing Address - Fax:404-296-8743
Practice Address - Street 1:5405 MEMORIAL DR STE 101
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30083-3234
Practice Address - Country:US
Practice Address - Phone:404-287-5406
Practice Address - Fax:404-296-8743
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-19
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management