Provider Demographics
NPI:1780457879
Name:PRIMECARECORP
Entity type:Organization
Organization Name:PRIMECARECORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MS
Authorized Official - First Name:YOLANDA
Authorized Official - Middle Name:CHAVEZ
Authorized Official - Last Name:MACADANGDANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-520-0034
Mailing Address - Street 1:PO BOX 7129
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-8939
Mailing Address - Country:US
Mailing Address - Phone:808-520-0034
Mailing Address - Fax:808-933-9304
Practice Address - Street 1:16-128 ORCHID LAND DRIVE
Practice Address - Street 2:
Practice Address - City:KEAAU
Practice Address - State:HI
Practice Address - Zip Code:96749
Practice Address - Country:US
Practice Address - Phone:808-520-0034
Practice Address - Fax:808-933-9304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-01
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No251C00000XAgenciesDay Training, Developmentally Disabled Services