NPI 1063124428
Prime Providers Id LLC
Practice location
- Address
- 950 W Bannock St STE 1100, Boise, ID 83702-6140
- Phone
- (208) 900-6330
- Mailing address
- 4200 Sepulveda Blvd STE 101, Culver City, CA 90230-4742
Authorised official
- Name
- Jonathan Sassover
- Title
- Authorized Signatory
- Phone
- (818) 377-6202
Registered specialties
In Home Supportive Care Agency
Primary
Registry record
- NPI
- 1063124428
- Entity type
- Organization
- NPI issued
- 16 Dec 2022
- Record last updated
- 16 Dec 2022
Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.