Provider Demographics
NPI:1881411239
Name:PRIMAC CARE LLC
Entity type:Organization
Organization Name:PRIMAC CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:UCHE
Authorized Official - Middle Name:
Authorized Official - Last Name:EWELIKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-418-7683
Mailing Address - Street 1:186 WILLOW TURN # A
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-3143
Mailing Address - Country:US
Mailing Address - Phone:856-418-7683
Mailing Address - Fax:
Practice Address - Street 1:186 WILLOW TURN # A
Practice Address - Street 2:
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-3143
Practice Address - Country:US
Practice Address - Phone:856-418-7683
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-25
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services