Provider Demographics
NPI:1700316106
Name:PRI-CARE INC
Entity type:Organization
Organization Name:PRI-CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TOLULOLA
Authorized Official - Middle Name:O
Authorized Official - Last Name:ADEOLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-524-1821
Mailing Address - Street 1:1735 HECKLE BLVD STE 103-303
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-4803
Mailing Address - Country:US
Mailing Address - Phone:803-524-1821
Mailing Address - Fax:704-380-9117
Practice Address - Street 1:1795 FRANK GASTON BLVD
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-1190
Practice Address - Country:US
Practice Address - Phone:803-524-1821
Practice Address - Fax:704-380-9117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-18
Last Update Date:2017-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC23570207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty