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General NPI Number Information
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NPI Number | 1821155342
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Entity Type | Organization
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Legal Business Name | PRIME ROSE HEALTHCARE STAFFING, LLC
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Dates
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Enumeration Date | 01/03/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 8201 TRADERS HOLLOW CT
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City | INDIANAPOLIS
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State | IN
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Zip | 46278-1297
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Country | US
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Telephone | 180-029-3179
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Fax |
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Provider Business Mailing Address
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Address Line | 743 CREEKWOOD DR
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City | WEST BEND
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State | WI
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Zip | 53095-7893
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Country | US
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Telephone | 800-293-1796
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | MR. NICHOLAS OMOLO BLASIO
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Credential | CPA
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Telephone | 317-293-1796
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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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