Provider Demographics
NPI:1124001805
Name:PRIMERA HOME HEALTHCARE
Entity Type:Organization
Organization Name:PRIMERA HOME HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:CANTERBURY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM, RN
Authorized Official - Phone:330-686-8317
Mailing Address - Street 1:450 W MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:HARTVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44632-9649
Mailing Address - Country:US
Mailing Address - Phone:330-686-8317
Mailing Address - Fax:330-686-8317
Practice Address - Street 1:450 W MAPLE ST
Practice Address - Street 2:
Practice Address - City:HARTVILLE
Practice Address - State:OH
Practice Address - Zip Code:44632-9649
Practice Address - Country:US
Practice Address - Phone:330-686-8317
Practice Address - Fax:330-686-8317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH135988163WH0200X
OH2825213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Multi-Specialty
Not Answered213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty