MEDICARE: PRIME CARE LIFE INC

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	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1891570834
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIME CARE LIFE INC

Provider Business Mailing Address
First Line	:	2561 PALMETTO RIDGE CIR
Second Line	:
City	:	APOPKA
State	:	FL
Zip	:	32712-1769
Country	:	US
Telephone Number	:	407-557-0030
Fax Number	:

Provider Business Practice Location Address
First Line	:	2561 PALMETTO RIDGE CIR
Second Line	:
City	:	APOPKA
State	:	FL
Zip	:	32712-1769
Country	:	US
Telephone Number	:	407-557-0030
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LIONEL NAU
Credential	:
Telephone Number	:	407-557-0030

Provider Enumeration Date	:	08/28/2023
Last Update Date	:	08/28/2023

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Directions to “PRIME CARE LIFE INC ” Practice Location

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