Healthcare Provider Details

I. General information

NPI: 1306776414
Provider Name (Legal Business Name): PRIME CARE SUPPORT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 W 300 N UNIT 602
SALT LAKE CITY UT
84116-4672
US

IV. Provider business mailing address

535 W 300 N UNIT 602
SALT LAKE CITY UT
84116-4672
US

V. Phone/Fax

Practice location:
  • Phone: 801-835-4353
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: MAHAMED MOHAMED
Title or Position: DIRECTOR
Credential:
Phone: 801-835-4353