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General NPI Number Information
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NPI Number | 1962252890
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Entity Type | Organization
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Legal Business Name | PRIME HOME HEALTHCARE LLC
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Dates
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Enumeration Date | 03/25/2024
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Last Update Date | 03/25/2024
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Provider Practice Location Address
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Address Line | 10910 LITTLE PATUXENT PKWY STE 204
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City | COLUMBIA
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State | MD
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Zip | 21044-3092
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Country | US
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Telephone | 301-404-4898
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Fax | 301-901-5270
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Provider Business Mailing Address
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Address Line | 11434 HIGH HAY DR
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City | COLUMBIA
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State | MD
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Zip | 21044-1027
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Country | US
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Telephone | 301-404-4898
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MOHAMMED JAWARA
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Credential | PTA
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Telephone | 301-404-4898
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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Taxonomy #5
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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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