Basic Information
| Provider Information | |||||||||
| NPI: | 1326092750 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PRIME CARE SEVEN, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10401 N MERIDIAN ST | ||||||||
| Address2: | SUITE 122 | ||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462901151 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3176303156 | ||||||||
| FaxNumber: | 3176303157 | ||||||||
| Practice Location | |||||||||
| Address1: | 700 E EUCLID AVE | ||||||||
| Address2: | |||||||||
| City: | PROSPECT HEIGHTS | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600703409 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8477972700 | ||||||||
| FaxNumber: | 8477972705 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/20/2006 | ||||||||
| LastUpdateDate: | 03/31/2010 | ||||||||
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| AuthorizedOfficialLastName: | HICKS | ||||||||
| AuthorizedOfficialFirstName: | JAY | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3176303156 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | PENDING | IL | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.