Provider Demographics
NPI:1982181426
Name:PRIME CARE SERVICES HOME CARE INCORPORATED
Entity Type:Organization
Organization Name:PRIME CARE SERVICES HOME CARE INCORPORATED
Other - Org Name:PRIME CARE HOME HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDOLO
Authorized Official - Middle Name:
Authorized Official - Last Name:AZENABOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-262-6400
Mailing Address - Street 1:2306 OAK LN STE 202
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75051-8270
Mailing Address - Country:US
Mailing Address - Phone:972-262-6400
Mailing Address - Fax:972-262-6544
Practice Address - Street 1:2306 OAK LN STE 202
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75051-8270
Practice Address - Country:US
Practice Address - Phone:972-262-6400
Practice Address - Fax:972-262-6544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-27
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Multi-Specialty
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========Medicaid