MEDICARE: PRIME HOME CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1043148083
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIME HOME CARE LLC

Provider Business Mailing Address
First Line	:	7067 W KNOWLEY RD
Second Line	:
City	:	WEST JORDAN
State	:	UT
Zip	:	84081-5099
Country	:	US
Telephone Number	:	801-999-4678
Fax Number	:

Provider Business Practice Location Address
First Line	:	4516 S 700 E STE 279
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84107-4192
Country	:	US
Telephone Number	:	801-999-4678
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	PATRICK NSABUMUGABE
Credential	:
Telephone Number	:	801-999-4678

Provider Enumeration Date	:	05/11/2026
Last Update Date	:	05/11/2026

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Directions to “PRIME HOME CARE LLC ” Practice Location

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