Organization
PRIMEWAY CONSULTING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GIMA MUDOH (C.E.O.)
(832) 385-1341
Entity
Organization
Contact information
Practice address
2712 FERDINAND, GRAND PRAIRIE, TX 75054-5519
(832) 385-1341
Mailing address
2712 FERDINAND, GRAND PRAIRIE, TX 75054-5519
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
—
—
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
—
—
Other
Enumeration date
06/26/2019
Last updated
06/26/2019
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