MEDICARE: PRIME SERVICES 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871853879
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIME SERVICES LLC

Provider Business Mailing Address
First Line	:	45593 SHEPARD DR
Second Line	:	SUITE 201
City	:	STERLING
State	:	VA
Zip	:	20164-4409
Country	:	US
Telephone Number	:	703-621-0668
Fax Number	:	703-790-5388

Provider Business Practice Location Address
First Line	:	45593 SHEPARD DR
Second Line	:	SUITE 201
City	:	STERLING
State	:	VA
Zip	:	20164-4409
Country	:	US
Telephone Number	:	703-621-0668
Fax Number	:	703-790-5388

Authorized Official
Title or Position	:	CO-OWNER
Name	:	MRS. OLUFUNKE BECKY OLOYEDE
Credential	:
Telephone Number	:	202-492-2704

Provider Enumeration Date	:	05/23/2012
Last Update Date	:	05/23/2012

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Directions to “PRIME SERVICES LLC ” Practice Location

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