Provider Demographics
NPI:1811889603
Name:PRIMECARE TRANSPORT LLC
Entity type:Organization
Organization Name:PRIMECARE TRANSPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DESALEGN
Authorized Official - Middle Name:
Authorized Official - Last Name:EJIGU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-550-9052
Mailing Address - Street 1:5665 AMNEST WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95835-1928
Mailing Address - Country:US
Mailing Address - Phone:916-550-9052
Mailing Address - Fax:
Practice Address - Street 1:500 JESSIE AVE
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95838-2609
Practice Address - Country:US
Practice Address - Phone:916-550-9052
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-16
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)