Provider Demographics
NPI:1821155342
Name:PRIME ROSE HEALTHCARE STAFFING, LLC
Entity Type:Organization
Organization Name:PRIME ROSE HEALTHCARE STAFFING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:OMOLO
Authorized Official - Last Name:BLASIO
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:317-293-1796
Mailing Address - Street 1:743 CREEKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WEST BEND
Mailing Address - State:WI
Mailing Address - Zip Code:53095-7893
Mailing Address - Country:US
Mailing Address - Phone:800-293-1796
Mailing Address - Fax:
Practice Address - Street 1:8201 TRADERS HOLLOW CT
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46278-1297
Practice Address - Country:US
Practice Address - Phone:180-029-3179
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health