Healthcare Provider Details

I. General information

NPI: 1487590543
Provider Name (Legal Business Name): PRIMECARE HEALTH & SUPPORT SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

88 WANDA CT
KENT OH
44240-1808
US

IV. Provider business mailing address

88 WANDA CT
KENT OH
44240-1808
US

V. Phone/Fax

Practice location:
  • Phone: 681-443-8615
  • Fax:
Mailing address:
  • Phone: 216-334-4317
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. OLUWAFUNKE REBECCA OLOFINSAWO
Title or Position: ADMINISTRATOR
Credential: PHD
Phone: 681-443-8615