MEDICARE: PRIMECARE HEALTH & SUPPORT SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1487590543
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIMECARE HEALTH & SUPPORT SERVICES LLC

Provider Business Mailing Address
First Line	:	88 WANDA CT
Second Line	:
City	:	KENT
State	:	OH
Zip	:	44240-1808
Country	:	US
Telephone Number	:	216-334-4317
Fax Number	:

Provider Business Practice Location Address
First Line	:	88 WANDA CT
Second Line	:
City	:	KENT
State	:	OH
Zip	:	44240-1808
Country	:	US
Telephone Number	:	681-443-8615
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	DR. OLUWAFUNKE REBECCA OLOFINSAWO
Credential	:	PHD
Telephone Number	:	681-443-8615

Provider Enumeration Date	:	04/28/2026
Last Update Date	:	04/28/2026

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