Healthcare Provider Details

I. General information

NPI: 1801485412
Provider Name (Legal Business Name): CMS PRIMARY HOME HEALTH CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2021
Last Update Date: 05/09/2025
Certification Date: 05/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E PARK BLVD STE 352
PLANO TX
75074-5483
US

IV. Provider business mailing address

101 E PARK BLVD STE 352
PLANO TX
75074-5704
US

V. Phone/Fax

Practice location:
  • Phone: 972-703-3448
  • Fax: 800-867-0804
Mailing address:
  • Phone: 318-779-2326
  • Fax: 800-867-0804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. TAMAKA SHANTA GRAHAM
Title or Position: OWNER
Credential:
Phone: 972-703-3448