Provider Demographics
NPI:1366625170
Name:PRIME CARE HOME HEALTH AGENCY INC
Entity Type:Organization
Organization Name:PRIME CARE HOME HEALTH AGENCY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:EUCHARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:OBASI
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:909-625-3200
Mailing Address - Street 1:PO BOX 1447
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91729-1447
Mailing Address - Country:US
Mailing Address - Phone:909-625-3200
Mailing Address - Fax:951-272-0289
Practice Address - Street 1:8401 WHITE OAK AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-3869
Practice Address - Country:US
Practice Address - Phone:909-625-3200
Practice Address - Fax:951-272-0289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-14
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA058225Medicare Oscar/Certification