Provider Demographics
NPI:1649813874
Name:PRIME HOME HEALTH, LLC
Entity type:Organization
Organization Name:PRIME HOME HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:IVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:VARGAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-251-4973
Mailing Address - Street 1:4400 S PIEDRAS DR STE 219
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78228-1223
Mailing Address - Country:US
Mailing Address - Phone:210-251-4973
Mailing Address - Fax:210-251-4467
Practice Address - Street 1:4400 S PIEDRAS DR STE 219
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78228-1223
Practice Address - Country:US
Practice Address - Phone:210-251-4973
Practice Address - Fax:210-251-4467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-21
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health