Provider Demographics
NPI:1871853879
Name:PRIME SERVICES LLC
Entity Type:Organization
Organization Name:PRIME SERVICES LLC
Other - Org Name:EXPEDITE HOME HEALTHCARE SERVICES, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:OLUFUNKE
Authorized Official - Middle Name:BECKY
Authorized Official - Last Name:OLOYEDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-492-2704
Mailing Address - Street 1:45593 SHEPARD DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20164-4409
Mailing Address - Country:US
Mailing Address - Phone:703-621-0668
Mailing Address - Fax:703-790-5388
Practice Address - Street 1:45593 SHEPARD DR
Practice Address - Street 2:SUITE 201
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20164-4409
Practice Address - Country:US
Practice Address - Phone:703-621-0668
Practice Address - Fax:703-790-5388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-23
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0156717008Medicaid
VA0157294650Medicaid