Provider Demographics
NPI:1376576173
Name:PRIMETIME HOME HEALTH SERVICES, INC
Entity Type:Organization
Organization Name:PRIMETIME HOME HEALTH SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHNSON
Authorized Official - Middle Name:OTUMBADI
Authorized Official - Last Name:NWOKORIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-977-7721
Mailing Address - Street 1:11602 BURDINE ST #A
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77035
Mailing Address - Country:US
Mailing Address - Phone:713-977-7721
Mailing Address - Fax:713-977-7728
Practice Address - Street 1:11602 BURDINE ST #A
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77035
Practice Address - Country:US
Practice Address - Phone:713-977-7721
Practice Address - Fax:713-977-7728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008140251E00000X
251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001012244OtherDADS
TX001012243OtherDADS
TX158169601Medicaid