Healthcare Provider Details

I. General information

NPI: 1477556751
Provider Name (Legal Business Name): PRIME CARE HEALTH AGENCY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 07/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11440 N KENDALL DR STE 500
MIAMI FL
33176-1025
US

IV. Provider business mailing address

11440 N KENDALL DR STE 500
MIAMI FL
33176-1025
US

V. Phone/Fax

Practice location:
  • Phone: 305-591-7774
  • Fax: 305-594-8951
Mailing address:
  • Phone: 305-591-7774
  • Fax: 305-594-8951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHHA20960096
License Number StateFL

VIII. Authorized Official

Name: MRS. MARIA GRIECO
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 305-591-7774