Provider Demographics
NPI:1811228489
Name:PRIME TIME ELDER CARE, LLC
Entity Type:Organization
Organization Name:PRIME TIME ELDER CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SHEIKNOR
Authorized Official - Middle Name:A
Authorized Official - Last Name:QASSIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-202-1517
Mailing Address - Street 1:220 S BROADWAY
Mailing Address - Street 2:SUITE 354
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55904-6514
Mailing Address - Country:US
Mailing Address - Phone:507-288-5499
Mailing Address - Fax:507-208-4349
Practice Address - Street 1:220 S BROADWAY
Practice Address - Street 2:SUITE 354
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55904-6514
Practice Address - Country:US
Practice Address - Phone:507-288-5499
Practice Address - Fax:507-208-4349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-21
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3442000-2251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health