Healthcare Provider Details

I. General information

NPI: 1952173064
Provider Name (Legal Business Name): PRIME HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2023
Last Update Date: 10/23/2023
Certification Date: 10/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

246 AUBURN ST APT 41
PORTLAND ME
04103-2155
US

IV. Provider business mailing address

246 AUBURN ST APT 41
PORTLAND ME
04103-2155
US

V. Phone/Fax

Practice location:
  • Phone: 207-409-4749
  • Fax:
Mailing address:
  • Phone: 207-409-4749
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: DIANE UWERA
Title or Position: CEO AND MANAGING DIRECTOR
Credential:
Phone: 207-409-4749