# PRIME CARE RESIDENTIAL AND BEHAVIORAL SERVICES

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1780523175
- **Authorized official:** MATILDA NAMUCHANA MASUMBA (DIRECTOR)
- **Authorized official phone:** (801) 815-3521

## Contact information

- **Practice address:** 6565 N 17TH AVE APT 11, PHOENIX, AZ 85015-1330
- **Practice address phone:** (801) 815-3521
- **Mailing address:** 6565 N 17TH AVE APT 11, PHOENIX, AZ 85015-1330
- **Mailing address phone:** (801) 815-3521

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 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 | — | NULL | Yes |
| 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