Healthcare Provider Details

I. General information

NPI: 1548190341
Provider Name (Legal Business Name): PRIMECARE HOME SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

72 TREACY AVE APT 1
NEWARK NJ
07108-3339
US

IV. Provider business mailing address

72 TREACY AVE APT 1
NEWARK NJ
07108-3339
US

V. Phone/Fax

Practice location:
  • Phone: 186-236-1451
  • Fax:
Mailing address:
  • Phone: 186-236-1451
  • 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: MS. ADIARA BALLO
Title or Position: ADMINISTRATOR
Credential: RN, BSN
Phone: 862-361-4518