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General NPI Number Information
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NPI Number | 1063332617
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Entity Type | Organization
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Legal Business Name | PRIMOR HOME HEALTH CARE LLC
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Dates
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Enumeration Date | 07/15/2026
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Last Update Date | 07/15/2026
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Provider Practice Location Address
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Address Line | 8660 MARYLAND CT N
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City | BROOKLYN PARK
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State | MN
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Zip | 55445-2664
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Country | US
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Telephone | 424-535-6255
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Fax |
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Provider Business Mailing Address
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Address Line | 8660 MARYLAND CT N
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City | BROOKLYN PARK
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State | MN
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Zip | 55445-2664
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Country | US
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Telephone | 424-535-6255
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | AZOMBUH YANICK AWUNGAFAC
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Credential |
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Telephone | 424-535-6255
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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