=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255376745
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PRIME HOME HEALTH INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/18/2006
-----------------------------------------------------
Last Update Date | 02/02/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10103 FONDREN RD STE 474
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77096-4671
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-777-8822
-----------------------------------------------------
Fax | 713-777-8822
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10103 FONDREN RD #474
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77096-4556
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-777-8822
-----------------------------------------------------
Fax | 713-777-8823
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MR. KENNETH O CHUKWUNENYE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 713-777-8822
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 008986
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------