Provider Demographics
NPI:1720637366
Name:PRIMARY PROVIDERS HOME CARE, LLC
Entity Type:Organization
Organization Name:PRIMARY PROVIDERS HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SHARRON
Authorized Official - Middle Name:
Authorized Official - Last Name:BUTTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-725-7354
Mailing Address - Street 1:726 DARTMOOR AVE
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08094-6310
Mailing Address - Country:US
Mailing Address - Phone:856-725-7354
Mailing Address - Fax:
Practice Address - Street 1:5333 ANGORA TER
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19143-3113
Practice Address - Country:US
Practice Address - Phone:856-725-7354
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-06
Last Update Date:2019-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health