Provider Demographics
NPI:1457826398
Name:PRICARE HEALTH LLC
Entity type:Organization
Organization Name:PRICARE HEALTH LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:O
Authorized Official - Last Name:BANJOKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-257-0225
Mailing Address - Street 1:PO BOX 17175
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33682-7175
Mailing Address - Country:US
Mailing Address - Phone:813-220-1400
Mailing Address - Fax:
Practice Address - Street 1:6506 EMBASSY BLVD
Practice Address - Street 2:
Practice Address - City:PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34668-4734
Practice Address - Country:US
Practice Address - Phone:727-378-2987
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MAIN STREET MEDICAL LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-10-08
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care