Provider Demographics
NPI:1689241614
Name:PRIME MISSION HOME CARE
Entity Type:Organization
Organization Name:PRIME MISSION HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIE-ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMES-LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE
Authorized Official - Phone:678-779-1936
Mailing Address - Street 1:120 MUIRFIELD DR
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30016-6535
Mailing Address - Country:US
Mailing Address - Phone:470-685-1099
Mailing Address - Fax:
Practice Address - Street 1:120 MUIRFIELD DR
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30016-6535
Practice Address - Country:US
Practice Address - Phone:470-685-1099
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-08
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child