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General NPI Number Information
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NPI Number | 1134524713
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Entity Type | Organization
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Legal Business Name | LE PRIME CARE, LLC
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Dates
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Enumeration Date | 10/25/2014
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Last Update Date | 01/24/2022
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Provider Practice Location Address
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Address Line | 2080 SUGARLOAF PKWY STE 100
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City | LAWRENCEVILLE
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State | GA
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Zip | 30045-9401
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Country | US
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Telephone | 770-686-3566
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Fax | 470-545-6432
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Provider Business Mailing Address
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Address Line | 2080 SUGARLOAF PKWY STE 100
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City | LAWRENCEVILLE
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State | GA
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Zip | 30045-9401
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Country | US
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Telephone | 770-686-3566
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Fax | 470-545-6432
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Authorized Official
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Title or Position | MANAGING DIRECTOR
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Name | MAXWELL YAOVI TENGUE
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Credential |
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Telephone | 770-686-3566
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number | 067-R-1241
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License Number State | GA
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