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Organization
PRIME CARE RESIDENTIAL AND BEHAVIORAL SERVICES
Active
Organization
PRIME CARE RESIDENTIAL AND BEHAVIORAL SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MATILDA NAMUCHANA MASUMBA (DIRECTOR)
(801) 815-3521
Entity
Organization
Contact information
Practice address
6565 N 17TH AVE APT 11, PHOENIX, AZ 85015-1330
(801) 815-3521
Mailing address
6565 N 17TH AVE APT 11, PHOENIX, AZ 85015-1330
(801) 815-3521
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
—
NULL
253J00000X
Foster Care Agency
—
NULL
253Z00000X
In Home Supportive Care Agency
—
NULL
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
NULL
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
NULL
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
—
NULL
385H00000X
Respite Care
—
NULL
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
—
NULL
385HR2065X
Child Physical Disabilities Respite Care
—
NULL
Other
Enumeration date
03/28/2026
Last updated
04/29/2026
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