Provider Demographics
NPI:1457176745
Name:PRIMESERVE LLC
Entity type:Organization
Organization Name:PRIMESERVE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEPUTY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MAPENZI
Authorized Official - Middle Name:K
Authorized Official - Last Name:KAHINDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-289-6152
Mailing Address - Street 1:1016 SE 6TH ST
Mailing Address - Street 2:
Mailing Address - City:GRIMES
Mailing Address - State:IA
Mailing Address - Zip Code:50111-1017
Mailing Address - Country:US
Mailing Address - Phone:515-289-6152
Mailing Address - Fax:
Practice Address - Street 1:1016 SE 6TH ST
Practice Address - Street 2:
Practice Address - City:GRIMES
Practice Address - State:IA
Practice Address - Zip Code:50111-1017
Practice Address - Country:US
Practice Address - Phone:515-289-6152
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-20
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services