Provider Demographics
NPI:1841024643
Name:PRIME COMMUNITY CARE, LLC
Entity type:Organization
Organization Name:PRIME COMMUNITY CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF BUSINESS DEVELOPMENT
Authorized Official - Prefix:
Authorized Official - First Name:KENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:HA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-922-5685
Mailing Address - Street 1:180 E OCEAN BLVD STE 250
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-4709
Mailing Address - Country:US
Mailing Address - Phone:424-326-8910
Mailing Address - Fax:424-329-8910
Practice Address - Street 1:15200 E GIRARD AVE STE 3150
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-5063
Practice Address - Country:US
Practice Address - Phone:424-326-8910
Practice Address - Fax:424-326-8910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-26
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care