Basic Information
| Provider Information | |||||||||
| NPI: | 1629025184 | ||||||||
| 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: | 855 E BASSE RD | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782091890 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2109301040 | ||||||||
| FaxNumber: | 2109301844 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/30/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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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 | TX | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.