Provider Demographics
NPI:1083632715
Name:PRIME HOME HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:PRIME HOME HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SAM
Authorized Official - Middle Name:D
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:847-803-8550
Mailing Address - Street 1:2604 DEMPSTER ST
Mailing Address - Street 2:SUITE 407
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-8412
Mailing Address - Country:US
Mailing Address - Phone:847-803-8550
Mailing Address - Fax:847-803-6819
Practice Address - Street 1:2604 DEMPSTER ST
Practice Address - Street 2:SUITE 407
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-8412
Practice Address - Country:US
Practice Address - Phone:847-803-8550
Practice Address - Fax:847-803-6819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1010473251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL147865Medicare ID - Type UnspecifiedPROVIDER NUMBER