Primecare Support Services LLC

Primary specialty

Community Health Clinic/CenterTaxonomy code 261QC1500X

Legal business name

PRIMECARE SUPPORT SERVICES LLC

Practice address

15004 Olddale Rd
Centreville, VA 20120-1433

Phone

(240) 899-0339

NPI assigned

Nov 12, 2025

Last updated

Nov 12, 2025By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kenneth Ashu Agbor Ojong

Title

Ceo

Phone

(240) 899-0339

Specialties & licenses 8

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1762905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1762905600000",
    "number": "1033079066",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15004 OLDDALE RD",
            "city": "CENTREVILLE",
            "state": "VA",
            "postal_code": "201201433",
            "telephone_number": "240-899-0339"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15004 OLDDALE RD",
            "city": "CENTREVILLE",
            "state": "VA",
            "postal_code": "201201433",
            "telephone_number": "240-899-0339"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIMECARE SUPPORT SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-11-12",
        "last_updated": "2025-11-12",
        "certification_date": "2025-11-12",
        "status": "A",
        "authorized_official_last_name": "OJONG",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "ASHU AGBOR",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "240-899-0339"
    },
    "taxonomies": [
        {
            "code": "103TM1800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Intellectual & Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QA0600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Day Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QD1600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.