MEDICARE: PRIME HOME HEALTH CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1518503366
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIME HOME HEALTH CARE LLC

Provider Business Mailing Address
First Line	:	11890 SUNRISE VALLEY DR
Second Line	:
City	:	RESTON
State	:	VA
Zip	:	20191-3302
Country	:	US
Telephone Number	:	571-722-0727
Fax Number	:

Provider Business Practice Location Address
First Line	:	11890 SUNRISE VALLEY DR
Second Line	:
City	:	RESTON
State	:	VA
Zip	:	20191-3302
Country	:	US
Telephone Number	:	571-722-0727
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	RAMANJEET KAUR
Credential	:
Telephone Number	:	571-722-0027

Provider Enumeration Date	:	11/26/2019
Last Update Date	:	06/19/2020

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