Healthcare Provider Details

I. General information

NPI: 1710665567
Provider Name (Legal Business Name): PRIME HEALTHCARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2023
Last Update Date: 03/13/2025
Certification Date: 03/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6210 N CAPITOL ST NW
WASHINGTON DC
20011-1416
US

IV. Provider business mailing address

3301 DUBOIS PL SE
WASHINGTON DC
20019-2479
US

V. Phone/Fax

Practice location:
  • Phone: 301-675-5755
  • Fax:
Mailing address:
  • Phone: 301-675-5755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: HELEN KEMBUMBARA
Title or Position: CEO
Credential:
Phone: 301-675-5755