Provider Demographics
NPI:1891570834
Name:PRIME CARE LIFE INC
Entity Type:Organization
Organization Name:PRIME CARE LIFE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LIONEL
Authorized Official - Middle Name:
Authorized Official - Last Name:NAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-557-0030
Mailing Address - Street 1:2561 PALMETTO RIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32712-1769
Mailing Address - Country:US
Mailing Address - Phone:407-557-0030
Mailing Address - Fax:
Practice Address - Street 1:2561 PALMETTO RIDGE CIR
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32712-1769
Practice Address - Country:US
Practice Address - Phone:407-557-0030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management