Provider Demographics
NPI:1760020507
Name:HOME CARE PRIME LLC
Entity Type:Organization
Organization Name:HOME CARE PRIME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HOME CARE
Authorized Official - Prefix:MRS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:CORBETT -SHEDD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-610-1215
Mailing Address - Street 1:2487 S BASSETT ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48217-1650
Mailing Address - Country:US
Mailing Address - Phone:313-610-1215
Mailing Address - Fax:313-228-5584
Practice Address - Street 1:2487 S BASSETT ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48217-1650
Practice Address - Country:US
Practice Address - Phone:313-610-1215
Practice Address - Fax:313-228-5584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-11
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health