Healthcare Provider Details

I. General information

NPI: 1376400879
Provider Name (Legal Business Name): PRIME HOME HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2026
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10910 LITTLE PATUXENT PKWY STE 204
COLUMBIA MD
21044-3092
US

IV. Provider business mailing address

10910 LITTLE PATUXENT PKWY STE 204
COLUMBIA MD
21044-3092
US

V. Phone/Fax

Practice location:
  • Phone: 301-814-8457
  • Fax:
Mailing address:
  • Phone: 301-814-8457
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: MOHAMMED JAWARA
Title or Position: VICE PRESIDENT
Credential:
Phone: 301-404-4898