Provider Demographics
NPI:1508050931
Name:PRIMROSE HOME HEALTH INC
Entity Type:Organization
Organization Name:PRIMROSE HOME HEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT/ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:AGUILAR
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:818-357-2421
Mailing Address - Street 1:1612 W OLIVE AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91506-2462
Mailing Address - Country:US
Mailing Address - Phone:818-357-2421
Mailing Address - Fax:818-435-2006
Practice Address - Street 1:1612 W OLIVE AVE STE 202
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91506-2462
Practice Address - Country:US
Practice Address - Phone:818-357-2421
Practice Address - Fax:818-435-2006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-29
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550000940251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1508050931Medicaid
CA059106Medicare Oscar/Certification