Healthcare Provider Details

I. General information

NPI: 1326092750
Provider Name (Legal Business Name): PRIME CARE SEVEN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 03/31/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 E EUCLID AVE
PROSPECT HEIGHTS IL
60070-3409
US

IV. Provider business mailing address

10401 N MERIDIAN ST SUITE 122
INDIANAPOLIS IN
46290-1151
US

V. Phone/Fax

Practice location:
  • Phone: 847-797-2700
  • Fax: 847-797-2705
Mailing address:
  • Phone: 317-630-3156
  • Fax: 317-630-3157

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberPENDING
License Number StateIL

VIII. Authorized Official

Name: JAY L HICKS
Title or Position: PRESIDENT
Credential:
Phone: 317-630-3156