Provider Demographics
NPI:1104405505
Name:PRIMAL POINTE HEALTH LLC
Entity type:Organization
Organization Name:PRIMAL POINTE HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:MWANGI
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:443-600-0181
Mailing Address - Street 1:8713 HARFORD RD STE 102
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-4650
Mailing Address - Country:US
Mailing Address - Phone:240-423-8757
Mailing Address - Fax:
Practice Address - Street 1:8713 HARFORD RD STE 102
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21234-4650
Practice Address - Country:US
Practice Address - Phone:240-423-8757
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRIMAL HEALTH CLINIC LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-04-05
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty