Provider Demographics
NPI:1023041605
Name:PRIME HOME CARE LLC
Entity Type:Organization
Organization Name:PRIME HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:K
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:MCHA
Authorized Official - Phone:402-390-2492
Mailing Address - Street 1:6818 GROVER ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68106-3640
Mailing Address - Country:US
Mailing Address - Phone:402-390-2492
Mailing Address - Fax:402-390-9070
Practice Address - Street 1:6818 GROVER ST
Practice Address - Street 2:SUITE 201
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68106-3640
Practice Address - Country:US
Practice Address - Phone:402-390-2492
Practice Address - Fax:402-390-9070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEHHA1042251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025193300Medicaid
NE287123Medicare ID - Type UnspecifiedPROVIDER NUMBER