Provider Demographics
NPI:1578075834
Name:PRIME ONE HOME CARE LLC
Entity Type:Organization
Organization Name:PRIME ONE HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:STEPHENIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:HUMPHRIES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-536-2354
Mailing Address - Street 1:5119 HIGHLAND RD STE 268
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48327-1915
Mailing Address - Country:US
Mailing Address - Phone:954-536-2354
Mailing Address - Fax:
Practice Address - Street 1:321 ARNOLD AVE
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341-1061
Practice Address - Country:US
Practice Address - Phone:954-536-2354
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-26
Last Update Date:2017-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health