Provider Demographics
NPI:1548077985
Name:PRIME SUPPORTS & CARE LLC
Entity type:Organization
Organization Name:PRIME SUPPORTS & CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:AKINWOLE
Authorized Official - Middle Name:FELLIX
Authorized Official - Last Name:ALEWI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-455-5732
Mailing Address - Street 1:9107 SUMMIT WAY
Mailing Address - Street 2:
Mailing Address - City:WATCHUNG
Mailing Address - State:NJ
Mailing Address - Zip Code:07069-7401
Mailing Address - Country:US
Mailing Address - Phone:917-455-5732
Mailing Address - Fax:
Practice Address - Street 1:9107 SUMMIT WAY
Practice Address - Street 2:
Practice Address - City:WATCHUNG
Practice Address - State:NJ
Practice Address - Zip Code:07069-7401
Practice Address - Country:US
Practice Address - Phone:917-455-5732
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-17
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services