Provider Demographics
NPI:1740933746
Name:PRIME HOME CARE LLC
Entity type:Organization
Organization Name:PRIME HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:NICODHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PAUL
Authorized Official - Suffix:
Authorized Official - Credentials:MHA
Authorized Official - Phone:561-705-1212
Mailing Address - Street 1:7157 W OAKLAND PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33313-1038
Mailing Address - Country:US
Mailing Address - Phone:954-520-7005
Mailing Address - Fax:772-600-3651
Practice Address - Street 1:7157 W OAKLAND PARK BLVD
Practice Address - Street 2:
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33313-1038
Practice Address - Country:US
Practice Address - Phone:954-520-7005
Practice Address - Fax:772-600-3651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-31
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Multi-Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty