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General NPI Number Information
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NPI Number | 1659994861
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Entity Type | Organization
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Legal Business Name | PRIME HOME CARE SERVICES LLC
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Dates
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Enumeration Date | 05/21/2020
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Last Update Date | 05/26/2020
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Provider Practice Location Address
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Address Line | 1225 NIMROD CT
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City | OSHKOSH
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State | WI
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Zip | 54902-2628
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Country | US
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Telephone | 920-385-7616
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Fax | 920-744-1763
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Provider Business Mailing Address
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Address Line | 1510 DICKENSON CT
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City | NEENAH
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State | WI
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Zip | 54956-5061
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Country | US
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Telephone | 920-385-7616
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Fax | 920-744-1763
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Authorized Official
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Title or Position | OWNER
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Name | MUSTAPHA SUNO
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Credential |
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Telephone | 920-265-3295
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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