1205828506 NPI number — PRIMARY HOME HEALTH CARE, INC.

Table of content: (NPI 1205828506)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205828506 NPI number — PRIMARY HOME HEALTH CARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRIMARY HOME HEALTH CARE, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PRIMARY HOME HEALTH CARE, INC.
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205828506
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/13/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1941 SOUTH 42ND ST
Provider Second Line Business Mailing Address:
SUITE 118 THE CENTER
Provider Business Mailing Address City Name:
OMAHA
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68105-2982
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-345-1350
Provider Business Mailing Address Fax Number:
402-345-1374

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1941 SOUTH 42ND ST
Provider Second Line Business Practice Location Address:
SUITE 118
Provider Business Practice Location Address City Name:
OMAHA
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68105-2982
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-345-1350
Provider Business Practice Location Address Fax Number:
402-345-1374
Provider Enumeration Date:
08/22/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BLAN
Authorized Official First Name:
JEANNINE
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
402-345-1350

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  261560 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 91184524500 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6085010 . This is a "UNITED HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 911845745-00 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0547935 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00793 . This is a "BLUE CROSS BLUE SHIELD NE" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".




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