MEDICARE: PRIMARY HOME CARE

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	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1164697579
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIMARY HOME CARE

Provider Business Mailing Address
First Line	:	760 WESTINGHOUSE DR
Second Line	:
City	:	HOT SPRINGS
State	:	AR
Zip	:	71901-1704
Country	:	US
Telephone Number	:	501-463-9590
Fax Number	:

Provider Business Practice Location Address
First Line	:	760 WESTINGHOUSE DR
Second Line	:
City	:	HOT SPRINGS
State	:	AR
Zip	:	71901-1704
Country	:	US
Telephone Number	:	501-463-9590
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. LARA MICHELLE THOMPSON
Credential	:	RN, MSN
Telephone Number	:	501-463-9590

Provider Enumeration Date	:	04/25/2008
Last Update Date	:	04/25/2008

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Directions to “PRIMARY HOME CARE ” Practice Location

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