Healthcare Provider Details

I. General information

NPI: 1689022998
Provider Name (Legal Business Name): PRIME LIFETIME SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2016
Last Update Date: 05/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 JUNIPER DR
AMHERST NH
03031-3028
US

IV. Provider business mailing address

12 JUNIPER DR
AMHERST NH
03031-3028
US

V. Phone/Fax

Practice location:
  • Phone: 978-837-1671
  • Fax:
Mailing address:
  • Phone: 978-837-1671
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-13-13156
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MRS. SABRINA RANDO
Title or Position: CEO
Credential: MS, BCBA
Phone: 978-837-1671