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General NPI Number Information
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NPI Number | 1245766310
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Entity Type | Organization
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Legal Business Name | PRIME PSYCHIATRIC CARE, LLC
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Dates
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Enumeration Date | 05/10/2017
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Last Update Date | 10/14/2021
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Provider Practice Location Address
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Address Line | 6245 LIVING PLACE SUITE 2085
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City | PITTSBURGH
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State | PA
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Zip | 15206
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Country | US
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Telephone | 412-274-0303
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Fax | 412-802-9156
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Provider Business Mailing Address
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Address Line | PO BOX 57430
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City | WASHINGTON
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State | DC
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Zip | 20037-0430
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Country | US
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Telephone | 412-412-0303
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Fax | 412-802-9156
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Authorized Official
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Title or Position | CEO
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Name | MR. LARRY J GOISSE
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Credential | MSN
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Telephone | 412-274-0303
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | SP014433
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License Number State | PA
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