Healthcare Provider Details

I. General information

NPI: 1881146009
Provider Name (Legal Business Name): PRNC OPERATING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2016
Last Update Date: 11/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 BUSHEY BLVD
PLATTSBURGH NY
12901-3761
US

IV. Provider business mailing address

8 BUSHEY BLVD
PLATTSBURGH NY
12901-3761
US

V. Phone/Fax

Practice location:
  • Phone: 518-563-3261
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number0901301N
License Number StateNY

VIII. Authorized Official

Name: ARIEH LEVI
Title or Position: BUSINESS OFFICE
Credential:
Phone: 914-597-7630