1205828506 NPI number — PRIMARY HOME HEALTH CARE, INC.

Table of Contents

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:
Provider Other Organization Name Type Code:
6
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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