Healthcare Provider Details

I. General information

NPI: 1689241614
Provider Name (Legal Business Name): PRIME MISSION HOME CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2021
Last Update Date: 05/05/2022
Certification Date: 05/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 MUIRFIELD DR
COVINGTON GA
30016-6535
US

IV. Provider business mailing address

120 MUIRFIELD DR
COVINGTON GA
30016-6535
US

V. Phone/Fax

Practice location:
  • Phone: 470-685-1099
  • Fax:
Mailing address:
  • Phone: 470-685-1099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: MRS. JULIE-ANN JAMES-LEWIS
Title or Position: OWNER
Credential: NURSE
Phone: 678-779-1936