Provider Demographics
NPI:1962637728
Name:PRIMECARE HOME CARE SERVICES, INC.
Entity Type:Organization
Organization Name:PRIMECARE HOME CARE SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:BERNARD
Authorized Official - Last Name:FLOURNOY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-696-3534
Mailing Address - Street 1:1930 ROBIN CIR
Mailing Address - Street 2:
Mailing Address - City:MILLEDGEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31061-2053
Mailing Address - Country:US
Mailing Address - Phone:478-696-3534
Mailing Address - Fax:478-451-0224
Practice Address - Street 1:1930 ROBIN CIR
Practice Address - Street 2:
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061-2053
Practice Address - Country:US
Practice Address - Phone:478-696-3534
Practice Address - Fax:478-451-0224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-22
Last Update Date:2009-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005-R-0400253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA334519490AMedicaid
GA334519490BMedicaid