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General NPI Number Information
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NPI Number | 1104409002
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Entity Type | Organization
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Legal Business Name | PRIME HOME CARE INC
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Dates
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Enumeration Date | 04/29/2021
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Last Update Date | 04/29/2021
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Provider Practice Location Address
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Address Line | 24 CRESCENT ST STE 307
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City | WALTHAM
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State | MA
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Zip | 02453-4360
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Country | US
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Telephone | 781-325-3605
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Fax |
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Provider Business Mailing Address
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Address Line | 100 POWDERMILL RD STE 173
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City | ACTON
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State | MA
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Zip | 01720-5932
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Country | US
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Telephone | 781-325-3605
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | PAULINE KUKUNDA KYAMBADE
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Credential |
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Telephone | 781-325-3605
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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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