Healthcare Provider Details

I. General information

NPI: 1013881382
Provider Name (Legal Business Name): PRIME BILLING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2025
Last Update Date: 02/20/2026
Certification Date: 02/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4304 SE 182ND AVE
GRESHAM OR
97030-5058
US

IV. Provider business mailing address

4304 SE 182ND AVE
GRESHAM OR
97030-5058
US

V. Phone/Fax

Practice location:
  • Phone: 978-569-4089
  • Fax:
Mailing address:
  • Phone: 978-569-4089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: PAUL NTEZA
Title or Position: DIRECTOR
Credential:
Phone: 978-569-4089