Provider Demographics
NPI:1386255131
Name:1ST PRIORITY HEALTHCARE LLC
Entity type:Organization
Organization Name:1ST PRIORITY HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SENECA
Authorized Official - Middle Name:G
Authorized Official - Last Name:DAVIDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-413-8765
Mailing Address - Street 1:1191 SALEM LAKE RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27107-1550
Mailing Address - Country:US
Mailing Address - Phone:336-413-8765
Mailing Address - Fax:502-286-6565
Practice Address - Street 1:4229 BARDSTOWN RD STE 201
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218-3286
Practice Address - Country:US
Practice Address - Phone:502-286-6565
Practice Address - Fax:502-286-6565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-14
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100695520Medicaid