Provider Demographics
NPI:1205828506
Name:PRIMARY HOME HEALTH CARE, INC.
Entity Type:Organization
Organization Name:PRIMARY HOME HEALTH CARE, INC.
Other - Org Name:PRIMARY HOME HEALTH CARE, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEANNINE
Authorized Official - Middle Name:A
Authorized Official - Last Name:BLAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-345-1350
Mailing Address - Street 1:1941 SOUTH 42ND ST
Mailing Address - Street 2:SUITE 118 THE CENTER
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68105-2982
Mailing Address - Country:US
Mailing Address - Phone:402-345-1350
Mailing Address - Fax:402-345-1374
Practice Address - Street 1:1941 SOUTH 42ND ST
Practice Address - Street 2:SUITE 118
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68105-2982
Practice Address - Country:US
Practice Address - Phone:402-345-1350
Practice Address - Fax:402-345-1374
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-22
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE261560251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE91184524500Medicaid
6085010OtherUNITED HEALTH CARE
NE911845745-00Medicaid
IA0547935Medicaid
NE00793OtherBLUE CROSS BLUE SHIELD NE
NE00793OtherBLUE CROSS BLUE SHIELD NE
NE287119Medicare PIN
IA0547935Medicaid