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
—
—
253J00000X
Foster Care Agency
—
—
253Z00000X
In Home Supportive Care Agency
—
—
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
—
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
—
—
385H00000X
Respite Care
—
—
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
—
—
385HR2065X
Child Physical Disabilities Respite Care
—
—
Other
Enumeration date
03/28/2026
Last updated
04/29/2026
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