Provider Demographics
NPI:1609809177
Name:PRIMIS HEALTHCARE SYSTEMS INC
Entity Type:Organization
Organization Name:PRIMIS HEALTHCARE SYSTEMS INC
Other - Org Name:ADVANCE HOME HEALTH CARE INC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:LILA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHERRI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-655-5555
Mailing Address - Street 1:1132 COOLIDGE HWY
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-7006
Mailing Address - Country:US
Mailing Address - Phone:248-655-5555
Mailing Address - Fax:248-655-0000
Practice Address - Street 1:1132 COOLIDGE HWY
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-7006
Practice Address - Country:US
Practice Address - Phone:248-655-5555
Practice Address - Fax:248-655-0000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIME0214888332B00000X, 332BC3200X, 332BP3500X, 332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOF30493OtherBCBS OF MI PROVIDER ID
MI1536696Medicaid
MI119406OtherGREAT LAKES HEALTH ID
MI3580OtherCAPE HEALTH PROVIDER ID
MI1536696Medicaid
MI3580OtherCAPE HEALTH PROVIDER ID