Provider Demographics
NPI:1265589220
Name:PRIME HOME CARE LLC
Entity type:Organization
Organization Name:PRIME HOME CARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:KIRSCH
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:402-390-2492
Mailing Address - Street 1:6818 GROVER ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68106-3640
Mailing Address - Country:US
Mailing Address - Phone:402-390-2492
Mailing Address - Fax:402-390-9070
Practice Address - Street 1:6818 GROVER ST
Practice Address - Street 2:SUITE 201
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68106-3640
Practice Address - Country:US
Practice Address - Phone:402-390-2492
Practice Address - Fax:402-390-9070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEHOSPICE33251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE100257364-00Medicaid
NE281535Medicare ID - Type UnspecifiedPROVIDER NUMBER