Provider Demographics
NPI:1093998262
Name:PRIMARY HEALTH CONCEPTS, INC.
Entity Type:Organization
Organization Name:PRIMARY HEALTH CONCEPTS, INC.
Other - Org Name:HOME HEALTH PROFESSIONALS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:NICK
Authorized Official - Middle Name:W
Authorized Official - Last Name:ELLEDGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-679-8852
Mailing Address - Street 1:1910 JAKE ALEXANDER BLVD W
Mailing Address - Street 2:SUITE 102-103
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28147-1162
Mailing Address - Country:US
Mailing Address - Phone:704-637-9461
Mailing Address - Fax:704-636-4483
Practice Address - Street 1:1910 JAKE ALEXANDER BLVD W
Practice Address - Street 2:SUITE 102-103
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28147-1162
Practice Address - Country:US
Practice Address - Phone:704-637-9461
Practice Address - Fax:704-636-4483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-11
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC0439251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6600215Medicaid