Provider Demographics
NPI:1265258883
Name:PRIME MEDHEALTH LLC
Entity type:Organization
Organization Name:PRIME MEDHEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:JOY
Authorized Official - Middle Name:ANWULI
Authorized Official - Last Name:ARAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-567-5258
Mailing Address - Street 1:17224 N 43RD AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-4025
Mailing Address - Country:US
Mailing Address - Phone:480-567-5258
Mailing Address - Fax:
Practice Address - Street 1:17224 N 43RD AVE STE 105
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-4025
Practice Address - Country:US
Practice Address - Phone:480-567-5258
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-27
Last Update Date:2024-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0800XAmbulatory Health Care FacilitiesClinic/CenterRecovery Care