=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871853879
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PRIME SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/23/2012
-----------------------------------------------------
Last Update Date | 05/23/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 45593 SHEPARD DR SUITE 201
-----------------------------------------------------
City | STERLING
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 20164-4409
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-621-0668
-----------------------------------------------------
Fax | 703-790-5388
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 45593 SHEPARD DR SUITE 201
-----------------------------------------------------
City | STERLING
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 20164-4409
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-621-0668
-----------------------------------------------------
Fax | 703-790-5388
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CO-OWNER
-----------------------------------------------------
Name | MRS. OLUFUNKE BECKY OLOYEDE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 202-492-2704
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------