Provider Demographics
NPI:1356358543
Name:PRIME CARE HOME HEALTH INC
Entity type:Organization
Organization Name:PRIME CARE HOME HEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:HORACIO
Authorized Official - Middle Name:
Authorized Official - Last Name:CANALES
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:361-334-9112
Mailing Address - Street 1:5926 S STAPLES ST STE D1
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78413-3843
Mailing Address - Country:US
Mailing Address - Phone:361-334-9112
Mailing Address - Fax:361-334-9114
Practice Address - Street 1:5926 S STAPLES ST STE D1
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78413-3843
Practice Address - Country:US
Practice Address - Phone:361-334-9112
Practice Address - Fax:361-334-9114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX010052251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX199703301Medicaid
TX45D1048360OtherCLIA