Healthcare Provider Details

I. General information

NPI: 1972305142
Provider Name (Legal Business Name): PRIME LIFE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2025
Last Update Date: 01/29/2026
Certification Date: 01/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2209 KELTRIP CT
SILVER SPRING MD
20906-1144
US

IV. Provider business mailing address

2209 KELTRIP CT
SILVER SPRING MD
20906-1144
US

V. Phone/Fax

Practice location:
  • Phone: 999-999-9999
  • Fax:
Mailing address:
  • Phone: 999-999-9999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: IHTESHAM KHAN
Title or Position: CEO
Credential:
Phone: 999-999-9999