Provider Demographics
NPI:1710997143
Name:PRIMECARE HOME HEALTH SERVICES INC.
Entity Type:Organization
Organization Name:PRIMECARE HOME HEALTH SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/ AGENCY SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:A
Authorized Official - Last Name:TOSSI
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:847-568-1778
Mailing Address - Street 1:7300 N CICERO AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:LINCOLNWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60712-1641
Mailing Address - Country:US
Mailing Address - Phone:847-568-1778
Mailing Address - Fax:847-568-1779
Practice Address - Street 1:7300 N CICERO AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:LINCOLNWOOD
Practice Address - State:IL
Practice Address - Zip Code:60712-1641
Practice Address - Country:US
Practice Address - Phone:847-568-1778
Practice Address - Fax:847-568-1779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1010505251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1010505Medicaid