Healthcare Provider Details

I. General information

NPI: 1912098633
Provider Name (Legal Business Name): PRIMA FOOD CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4020 NE 10TH WAY
POMPANO BEACH FL
33064-5169
US

IV. Provider business mailing address

4020 NE 10TH WAY
POMPANO BEACH FL
33064-5169
US

V. Phone/Fax

Practice location:
  • Phone: 954-788-0411
  • Fax: 954-788-0207
Mailing address:
  • Phone: 954-788-0411
  • Fax: 954-788-0207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License NumberCAT1618359
License Number StateFL

VIII. Authorized Official

Name: MR. RICARDO D. WODNICKI
Title or Position: PRESIDENT
Credential:
Phone: 954-788-0411