Provider Demographics
NPI:1548591852
Name:PRIMECARE HOMEHEALTH AGENCY,LLC
Entity Type:Organization
Organization Name:PRIMECARE HOMEHEALTH AGENCY,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LOLITA
Authorized Official - Middle Name:E
Authorized Official - Last Name:CHING
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:702-286-1381
Mailing Address - Street 1:3160 W SAHARA AVE
Mailing Address - Street 2:SUITE A25
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-6003
Mailing Address - Country:US
Mailing Address - Phone:702-457-9000
Mailing Address - Fax:702-457-9005
Practice Address - Street 1:3160 W SAHARA AVE
Practice Address - Street 2:SUITE A25
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-6003
Practice Address - Country:US
Practice Address - Phone:702-457-9000
Practice Address - Fax:702-457-9005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-26
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVH14-00271-E-147574251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health