Provider Demographics
NPI:1265869119
Name:PRIMA SERAPH
Entity type:Organization
Organization Name:PRIMA SERAPH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:C
Authorized Official - Last Name:HOLDEN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:281-702-0180
Mailing Address - Street 1:3010 DEMI LN
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77523-8672
Mailing Address - Country:US
Mailing Address - Phone:281-702-0180
Mailing Address - Fax:
Practice Address - Street 1:3010 DEMI LN
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77523-8672
Practice Address - Country:US
Practice Address - Phone:281-702-0180
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-07
Last Update Date:2013-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies