Provider Demographics
NPI:1598716136
Name:PRIME HOME HEALTH, LLC
Entity Type:Organization
Organization Name:PRIME HOME HEALTH, LLC
Other - Org Name:SIGNATURE HEALTHCARE AT HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:PT, MSPT
Authorized Official - Phone:971-979-0774
Mailing Address - Street 1:7632 SW DURHAM RD STE 105
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-7597
Mailing Address - Country:US
Mailing Address - Phone:844-744-2200
Mailing Address - Fax:
Practice Address - Street 1:909 S 336TH ST STE 100
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-7394
Practice Address - Country:US
Practice Address - Phone:253-661-5166
Practice Address - Fax:253-661-5359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-15
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA507110Medicare Oscar/Certification