Provider Demographics
NPI:1952883894
Name:IMPERIAL PRIMARY HEALTH & HOME CARE SERVICES, LLC
Entity Type:Organization
Organization Name:IMPERIAL PRIMARY HEALTH & HOME CARE SERVICES, LLC
Other - Org Name:IMPERIAL HEALTH & HOME CARE SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMESHIA
Authorized Official - Middle Name:D
Authorized Official - Last Name:BUSH-TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:251-654-7453
Mailing Address - Street 1:451 S BROAD ST
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36603-1121
Mailing Address - Country:US
Mailing Address - Phone:251-654-7453
Mailing Address - Fax:251-380-6973
Practice Address - Street 1:451 S BROAD ST
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36603-1121
Practice Address - Country:US
Practice Address - Phone:251-654-7453
Practice Address - Fax:251-380-6973
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-06
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174200000X, 177F00000X, 253Z00000X, 261QC1800X, 261QH0100X, 261QP2300X, 363LF0000X, 385H00000X
AL1-081016376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty
No174200000XOther Service ProvidersMealsGroup - Single Specialty
No177F00000XOther Service ProvidersLodgingGroup - Single Specialty
No253Z00000XAgenciesIn Home Supportive Care
No261QC1800XAmbulatory Health Care FacilitiesClinic/CenterCorporate Health
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No385H00000XRespite Care FacilityRespite CareGroup - Single Specialty