Provider Demographics
NPI:1386352003
Name:PRC INTEGRATED CARE
Entity type:Organization
Organization Name:PRC INTEGRATED CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED CONTACT
Authorized Official - Prefix:
Authorized Official - First Name:FELICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SUMLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-570-6444
Mailing Address - Street 1:264 N EXETER ST
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-4657
Mailing Address - Country:US
Mailing Address - Phone:602-706-4405
Mailing Address - Fax:
Practice Address - Street 1:301 W MCDOWELL RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85003-1214
Practice Address - Country:US
Practice Address - Phone:602-706-4405
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-10
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)