Healthcare Provider Details

I. General information

NPI: 1508685637
Provider Name (Legal Business Name): PRIMECARE PRACTITIONERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2024
Last Update Date: 12/17/2024
Certification Date: 12/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5800 FLEET AVE STE 2
CLEVELAND OH
44105-3404
US

IV. Provider business mailing address

5800 FLEET AVE STE 2
CLEVELAND OH
44105-3404
US

V. Phone/Fax

Practice location:
  • Phone: 440-228-8302
  • Fax: 440-484-5535
Mailing address:
  • Phone: 440-228-8302
  • Fax: 440-484-5535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code282E00000X
TaxonomyLong Term Care Hospital
License Number
License Number StateNULL

VIII. Authorized Official

Name: JULIE DOBRIANSKY
Title or Position: NURSE PRACTITIONER
Credential: NP
Phone: 440-228-8302