Healthcare Provider Details

I. General information

NPI: 1881557601
Provider Name (Legal Business Name): PRIME CARE BEHAVIORAL HEALTH AND WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11604 CARROLL COVE
FORT WAYNE IN
46818
US

IV. Provider business mailing address

429 E DUPONT RD # 1074
FORT WAYNE IN
46825-2051
US

V. Phone/Fax

Practice location:
  • Phone: 713-962-0447
  • Fax: 888-908-3641
Mailing address:
  • Phone: 713-962-0447
  • Fax: 888-908-3641

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: BIANCA OSAKWE
Title or Position: OWNER
Credential:
Phone: 260-589-5336