Provider Demographics
NPI:1013883792
Name:PRIMAL RESIDENTIAL CARE SERVICES LLC
Entity type:Organization
Organization Name:PRIMAL RESIDENTIAL CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MBWAMEH
Authorized Official - Middle Name:KIAMBOM
Authorized Official - Last Name:SAMA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:703-398-9323
Mailing Address - Street 1:9422 THREE STONE LN
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-3393
Mailing Address - Country:US
Mailing Address - Phone:703-398-9323
Mailing Address - Fax:
Practice Address - Street 1:9422 THREE STONE LN
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-3393
Practice Address - Country:US
Practice Address - Phone:703-398-9323
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-11
Last Update Date:2025-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities