Provider Demographics
NPI:1659540862
Name:PRIMARY HOME HEALTH CARE, INC.
Entity Type:Organization
Organization Name:PRIMARY HOME HEALTH CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:PRIME
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:719-577-4272
Mailing Address - Street 1:111 E. POLK STREET
Mailing Address - Street 2:111 E. POLK STREET
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-6227
Mailing Address - Country:US
Mailing Address - Phone:719-577-4272
Mailing Address - Fax:719-227-9272
Practice Address - Street 1:111 E. POLK STREET
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-6227
Practice Address - Country:US
Practice Address - Phone:719-577-4272
Practice Address - Fax:719-227-9272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-21
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X
CO04G501251E00000X
CO04K988253Z00000X
CO040244376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO37422791Medicaid
CO41652576Medicaid
067476Medicare Oscar/Certification