Provider Demographics
NPI:1316494032
Name:PRIMUS INCORPORATED
Entity type:Organization
Organization Name:PRIMUS INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAIWO
Authorized Official - Middle Name:REMILEKUN
Authorized Official - Last Name:OBAZELUWA-AFOLAYAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:763-732-3729
Mailing Address - Street 1:7309 KENTUCKY AVE N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55428-1222
Mailing Address - Country:US
Mailing Address - Phone:763-732-3729
Mailing Address - Fax:
Practice Address - Street 1:7309 KENTUCKY AVE N
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55428-1222
Practice Address - Country:US
Practice Address - Phone:763-269-9241
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-10
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN377540251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health