Healthcare Provider Details

I. General information

NPI: 1043148083
Provider Name (Legal Business Name): PRIME HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4516 S 700 E STE 279
SALT LAKE CITY UT
84107-4192
US

IV. Provider business mailing address

7067 W KNOWLEY RD
WEST JORDAN UT
84081-5099
US

V. Phone/Fax

Practice location:
  • Phone: 801-999-4678
  • Fax:
Mailing address:
  • Phone: 801-999-4678
  • 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: PATRICK NSABUMUGABE
Title or Position: OWNER/PRESIDENT
Credential:
Phone: 801-999-4678