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General NPI Number Information
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NPI Number | 1326312828
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Entity Type | Organization
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Legal Business Name | PRIMACARE
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Dates
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Enumeration Date | 03/01/2012
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Last Update Date | 03/01/2012
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Provider Practice Location Address
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Address Line | 1810 E 86TH ST
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City | CLEVELAND
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State | OH
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Zip | 44106-2019
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Country | US
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Telephone | 216-213-1079
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 771361
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City | LAKEWOOD
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State | OH
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Zip | 44107-0056
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | WALTER L MCCALL
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Credential |
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Telephone | 216-213-1079
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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