1265589220 NPI number — PRIME HOME CARE LLC

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 1265589220 NPI number — PRIME HOME CARE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRIME HOME CARE LLC
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:
COMPASSIONATE CARE HOSPICE
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:
1265589220
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/23/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6818 GROVER ST
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
OMAHA
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68106-3640
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-390-2492
Provider Business Mailing Address Fax Number:
402-390-9070

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6818 GROVER ST
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
OMAHA
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68106-3640
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-390-2492
Provider Business Practice Location Address Fax Number:
402-390-9070
Provider Enumeration Date:
01/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KIRSCH
Authorized Official First Name:
TAMMY
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
402-390-2492

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X , with the licence number:  HOSPICE33 , 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: 100257364-00 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".




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