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NPI Code Detail

MEDICARE: PRIME CARE BEHAVIORAL HEALTH AND WELLNESS, LLC

MEDICARE: PRIME CARE BEHAVIORAL HEALTH AND WELLNESS, 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
1363LF0000XFamily Nurse Practitioner
2363LP0808XPsychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number : 1881557601
Entity Type Code : Organization
Provider Name (Legal Business Name) : PRIME CARE BEHAVIORAL HEALTH AND WELLNESS, LLC
Provider Business Mailing Address
First Line : 429 E DUPONT RD # 1074
Second Line :
City : FORT WAYNE
State : IN
Zip : 46825-2051
Country : US
Telephone Number : 713-962-0447
Fax Number : 888-908-3641
Provider Business Practice Location Address
First Line : 11604 CARROLL COVE
Second Line :
City : FORT WAYNE
State : IN
Zip : 46818
Country : US
Telephone Number : 713-962-0447
Fax Number : 888-908-3641
Authorized Official
Title or Position : OWNER
Name : BIANCA OSAKWE
Credential :
Telephone Number : 260-589-5336
Provider Enumeration Date : 12/08/2025
Last Update Date : 12/08/2025

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Directions to “PRIME CARE BEHAVIORAL HEALTH AND WELLNESS, LLC ” Practice Location

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