Provider Demographics
NPI:1013457621
Name:PRIME HOME HEALTH OF LEE COUNTY, LLC
Entity Type:Organization
Organization Name:PRIME HOME HEALTH OF LEE COUNTY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEDBETTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-745-7966
Mailing Address - Street 1:2125 EXECUTIVE PARK DR
Mailing Address - Street 2:
Mailing Address - City:OPELIKA
Mailing Address - State:AL
Mailing Address - Zip Code:36801-6041
Mailing Address - Country:US
Mailing Address - Phone:334-745-7966
Mailing Address - Fax:334-745-2153
Practice Address - Street 1:2125 EXECUTIVE PARK DR
Practice Address - Street 2:
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36801-6041
Practice Address - Country:US
Practice Address - Phone:334-745-7966
Practice Address - Fax:334-745-2153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-01
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALSOU714AMedicaid
ALSOU714AMedicaid