Provider Demographics
NPI:1851153134
Name:PRIME HOMECARE AKA PRIME HOMECARE LLC
Entity Type:Organization
Organization Name:PRIME HOMECARE AKA PRIME HOMECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:OMAR
Authorized Official - Middle Name:A
Authorized Official - Last Name:MOHAMED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-239-9525
Mailing Address - Street 1:650 MAIN ST STE 201A
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-5448
Mailing Address - Country:US
Mailing Address - Phone:207-239-9525
Mailing Address - Fax:207-544-5398
Practice Address - Street 1:650 MAIN ST STE 201A
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-5448
Practice Address - Country:US
Practice Address - Phone:207-239-9525
Practice Address - Fax:207-544-5398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-23
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care