Organization
PRIMECARE, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES MICHAEL KELLY (MANGEMENT AGENT)
(203) 597-8525
Entity
Organization
Contact information
Practice address
562 WATERTOWN AVE, WATERBURY, CT 06708-2240
(203) 597-8525
Mailing address
562 WATERTOWN AVE, #3, WATERBURY, CT 06708-2240
(203) 597-8525
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
63659
—
CT
Enumeration date
01/06/2015
Last updated
01/06/2015
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