Healthcare Provider Details

I. General information

NPI: 1386438059
Provider Name (Legal Business Name): PRIME HEALTHCARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2025
Last Update Date: 08/16/2025
Certification Date: 08/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12818 ODENS BEQUEST DR
BOWIE MD
20720-5614
US

IV. Provider business mailing address

609 H ST NE # 304
WASHINGTON DC
20002-7184
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 Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

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