Provider Demographics
NPI:1255376745
Name:PRIME HOME HEALTH INC
Entity type:Organization
Organization Name:PRIME HOME HEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:O
Authorized Official - Last Name:CHUKWUNENYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-777-8822
Mailing Address - Street 1:10103 FONDREN RD
Mailing Address - Street 2:#474
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77096-4556
Mailing Address - Country:US
Mailing Address - Phone:713-777-8822
Mailing Address - Fax:713-777-8823
Practice Address - Street 1:10103 FONDREN RD STE 474
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77096-4671
Practice Address - Country:US
Practice Address - Phone:713-777-8822
Practice Address - Fax:713-777-8822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008986251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1768277-01Medicaid
TX1768277-02Medicaid
TX1768277-02Medicaid