Provider Demographics
NPI:1093752446
Name:PRIME CHOICE HOME HEALTH INC.
Entity Type:Organization
Organization Name:PRIME CHOICE HOME HEALTH INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AGNES
Authorized Official - Middle Name:
Authorized Official - Last Name:BELLAMY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-926-0014
Mailing Address - Street 1:12611 HIDDENCREEK WAY STE I
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-2147
Mailing Address - Country:US
Mailing Address - Phone:562-926-0014
Mailing Address - Fax:562-926-0013
Practice Address - Street 1:12611 HIDDENCREEK WAY STE I
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703
Practice Address - Country:US
Practice Address - Phone:562-926-0014
Practice Address - Fax:562-926-0013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2019-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA980001504251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05-8245Medicare ID - Type UnspecifiedCMS MEDICARE PROVIDER NO
CAL00003AMedicare ID - Type UnspecifiedMEDICARE PART B PROV. NO.