Provider Demographics
NPI:1376991893
Name:PRIMARY HOME HEALTH CARE, INC.
Entity Type:Organization
Organization Name:PRIMARY HOME HEALTH CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:PRIME
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:719-577-4272
Mailing Address - Street 1:111 E. POLK STREET
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-6227
Mailing Address - Country:US
Mailing Address - Phone:719-577-4272
Mailing Address - Fax:719-227-9272
Practice Address - Street 1:111 E POLK STREET
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-6227
Practice Address - Country:US
Practice Address - Phone:719-577-4272
Practice Address - Fax:719-227-9272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-25
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO04O244253Z00000X
CO04K988253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO41652576Medicaid