Provider Demographics
NPI:1861807760
Name:PRIME HEALTHCARE SERVICES - GARDEN CITY LLC
Entity type:Organization
Organization Name:PRIME HEALTHCARE SERVICES - GARDEN CITY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:REGIONAL CFO
Authorized Official - Prefix:
Authorized Official - First Name:GINA
Authorized Official - Middle Name:S
Authorized Official - Last Name:BUTCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-458-4692
Mailing Address - Street 1:3300 E GUASTI RD
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91761-8655
Mailing Address - Country:US
Mailing Address - Phone:909-235-4300
Mailing Address - Fax:
Practice Address - Street 1:6245 INKSTER RD
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:MI
Practice Address - Zip Code:48135-4001
Practice Address - Country:US
Practice Address - Phone:734-421-3300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRIME HEALTHCARE HOLDINGS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-06-30
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI00006OtherBCBS OF MICHIGAN
MI23T244Medicare Oscar/Certification