Provider Demographics
NPI:1154804813
Name:PRIME HOME CARE, INC
Entity type:Organization
Organization Name:PRIME HOME CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ARK
Authorized Official - Middle Name:
Authorized Official - Last Name:LIBKIND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-872-5440
Mailing Address - Street 1:9735 BUSTLETON AVE
Mailing Address - Street 2:SUITE 2N
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19115
Mailing Address - Country:US
Mailing Address - Phone:800-515-0526
Mailing Address - Fax:800-905-7584
Practice Address - Street 1:9735 BUSTLETON AVE
Practice Address - Street 2:SUITE 2N
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19115-1109
Practice Address - Country:US
Practice Address - Phone:800-515-0526
Practice Address - Fax:800-905-7584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-10
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1033613590001Medicaid