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General NPI Number Information
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NPI Number | 1912661174
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Entity Type | Organization
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Legal Business Name | PRIMECARE GLOBAL SERVICES CORP
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Dates
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Enumeration Date | 10/25/2021
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Last Update Date | 10/25/2021
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Provider Practice Location Address
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Address Line | 5493 STONEVIEW RD
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91739-8933
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Country | US
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Telephone | 714-863-9560
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Fax |
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Provider Business Mailing Address
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Address Line | 5493 STONEVIEW RD
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91739-8933
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Country | US
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Telephone | 714-863-9560
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | ERNEST ASHU TAKANG
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Credential | NURSE PRACTITIONER
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Telephone | 714-863-9560
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 273R00000X
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Taxonomy Name | Psychiatric Hospital Unit
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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