Provider Demographics
NPI:1245571108
Name:PRIME HOME CARE MIDWAY, INC
Entity Type:Organization
Organization Name:PRIME HOME CARE MIDWAY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF LEGAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:BONACCORSI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-762-9999
Mailing Address - Street 1:33 S STATE ST FL 5
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60603-2804
Mailing Address - Country:US
Mailing Address - Phone:312-762-9999
Mailing Address - Fax:
Practice Address - Street 1:1342 W. 4TH STREET
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44906-1828
Practice Address - Country:US
Practice Address - Phone:419-529-0900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RITECHOICE HEALTHCARE SERVICES. LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-03-01
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0109512Medicaid