Provider Demographics
NPI:1528606068
Name:PRIME PROFESSIONAL HOME HEALTH INC
Entity Type:Organization
Organization Name:PRIME PROFESSIONAL HOME HEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SIMONE
Authorized Official - Middle Name:DESIREE
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-892-0604
Mailing Address - Street 1:13515A LAWING DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23834-6018
Mailing Address - Country:US
Mailing Address - Phone:804-892-0604
Mailing Address - Fax:804-796-6257
Practice Address - Street 1:13515A LAWING DR
Practice Address - Street 2:
Practice Address - City:SOUTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23834-6018
Practice Address - Country:US
Practice Address - Phone:804-892-0604
Practice Address - Fax:804-796-6257
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-16
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care