Provider Demographics
NPI:1134524713
Name:LE PRIME CARE, LLC
Entity type:Organization
Organization Name:LE PRIME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MAXWELL
Authorized Official - Middle Name:YAOVI
Authorized Official - Last Name:TENGUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-686-3566
Mailing Address - Street 1:2080 SUGARLOAF PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30045-9401
Mailing Address - Country:US
Mailing Address - Phone:770-686-3566
Mailing Address - Fax:470-545-6432
Practice Address - Street 1:2080 SUGARLOAF PKWY STE 100
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30045-9401
Practice Address - Country:US
Practice Address - Phone:770-686-3566
Practice Address - Fax:470-545-6432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-25
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA067-R-1241251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care