PRIMECARE SUPPORT SERVICES LLC NPI 1033079066

NPI Information

  • NPI: 1033079066
  • Provider Name: PRIMECARE SUPPORT SERVICES LLC
  • Classification: Clinic/Center - 261QC1500X
  • Specialization: Community Health
  • Entity Type: Organization
  • Address: 15004 OLDDALE RD
    CENTREVILLE, VA
    ZIP 20120
  • Phone: (240) 899-0339

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NPI Details

PRIMECARE SUPPORT SERVICES LLC is a community health clinic center in Centreville, VA. PRIMECARE SUPPORT SERVICES LLC NPI is 1033079066. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

15004 OLDDALE RD
CENTREVILLE, VA
ZIP 20120-433
Phone: (240) 899-0339

The provider's authorized official is Kenneth Ashu Agbor Ojong .
The authorized official title is Ceo and has the following contact phone number (240) 899-0339.

The enumeration date for this NPI number is 11/12/2025 and was last updated on 11/12/2025.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1103TM1800XPsychologistIntellectual and Developmental DisabilitiesNo
2251E00000XHome HealthNo
3251S00000XCommunity/Behavioral HealthNo
4253Z00000XIn Home Supportive CareNo
5261QA0600XClinic/CenterAdult Day CareNo
6261QD1600XClinic/CenterDevelopmental DisabilitiesNo
7261QM0850XClinic/CenterAdult Mental HealthNo
8261QC1500XClinic/CenterCommunity HealthYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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