Organization
PRIME PROVIDERS ID LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JONATHAN SASSOVER (AUTHORIZED SIGNATORY)
(818) 377-6202
Entity
Organization
Contact information
Practice address
950 W BANNOCK ST STE 1100, BOISE, ID 83702-6140
(208) 900-6330
Mailing address
4200 SEPULVEDA BLVD STE 101, CULVER CITY, CA 90230-4742
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
—
—
Other
Enumeration date
12/16/2022
Last updated
12/16/2022
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