Organization · NPI-2

Primecare Support Services LLC

Clinic/Center, Community Health · Centreville, VA

NPI number1033079066

StatusActive

Last updated in NPPESNov 12, 2025

Details

NPI: 1033079066
Entity type: Organization (NPI-2)
Legal business name: Primecare Support Services LLC
Organization subpart: No
Enumeration date: Nov 12, 2025
Certification date: Nov 12, 2025
Last updated: Nov 12, 2025

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
261QC1500X	Clinic/Center, Community Health	–	–	Yes
103TM1800X	Psychologist, Intellectual & Developmental Disabilities	–	–
251E00000X	Home Health	–	–
251S00000X	Community/Behavioral Health	–	–
253Z00000X	In Home Supportive Care	–	–
261QA0600X	Clinic/Center, Adult Day Care	–	–
261QD1600X	Clinic/Center, Developmental Disabilities	–	–
261QM0850X	Clinic/Center, Adult Mental Health	–	–

Practice location

15004 Olddale Rd
Centreville, VA 20120-1433

Phone 240-899-0339

Mailing address

15004 Olddale Rd
Centreville, VA 20120-1433

Phone 240-899-0339

Authorized official

Kenneth Ashu Agbor Ojong
Ceo
2408990339

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