Provider Demographics
NPI:1720391097
Name:PRIME CARE THERAPEUTIC SERVICES INC.
Entity Type:Organization
Organization Name:PRIME CARE THERAPEUTIC SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ASMAT
Authorized Official - Middle Name:
Authorized Official - Last Name:BININASHVILI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-893-5844
Mailing Address - Street 1:14435 HAMLIN ST STE 108
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91401-6205
Mailing Address - Country:US
Mailing Address - Phone:323-893-5844
Mailing Address - Fax:
Practice Address - Street 1:14435 HAMLIN ST STE 108
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91401-6205
Practice Address - Country:US
Practice Address - Phone:323-893-5844
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-15
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18811225100000X
CA9023225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADN447AMedicare UPIN