Provider Demographics
NPI:1255383659
Name:PRIME CRITICAL HOME CARE, INC.
Entity type:Organization
Organization Name:PRIME CRITICAL HOME CARE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUGANTHI
Authorized Official - Middle Name:
Authorized Official - Last Name:APPAVU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-783-0095
Mailing Address - Street 1:8320 LEMONT RD
Mailing Address - Street 2:
Mailing Address - City:DARIEN
Mailing Address - State:IL
Mailing Address - Zip Code:60561-1510
Mailing Address - Country:US
Mailing Address - Phone:630-783-0095
Mailing Address - Fax:630-783-9130
Practice Address - Street 1:8320 LEMONT RD
Practice Address - Street 2:
Practice Address - City:DARIEN
Practice Address - State:IL
Practice Address - Zip Code:60561-1510
Practice Address - Country:US
Practice Address - Phone:630-783-0095
Practice Address - Fax:630-783-9130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1010315251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL=========001Medicaid