Healthcare Provider Details

I. General information

NPI: 1346694346
Provider Name (Legal Business Name): PRIME CARE HEALTH SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2016
Last Update Date: 11/29/2022
Certification Date: 11/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

451 E CARSON PLAZA DR STE 101
CARSON CA
90746-3210
US

IV. Provider business mailing address

451 E CARSON PLAZA DR STE 101
CARSON CA
90746-3210
US

V. Phone/Fax

Practice location:
  • Phone: 310-418-5391
  • Fax: 310-381-0039
Mailing address:
  • Phone: 424-558-3846
  • Fax: 310-381-0039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateCA

VIII. Authorized Official

Name: MR. AUGUSTINE CHIDEBE
Title or Position: PRESIDENT/CEO
Credential:
Phone: 310-418-5391