MEDICARE: PRIME LIVING 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	:	1255855870
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIME LIVING CARE LLC

Provider Business Mailing Address
First Line	:	430 W MERRICK RD STE 21
Second Line	:
City	:	VALLEY STREAM
State	:	NY
Zip	:	11580-5201
Country	:	US
Telephone Number	:	786-853-8863
Fax Number	:

Provider Business Practice Location Address
First Line	:	430 W MERRICK RD STE 21
Second Line	:
City	:	VALLEY STREAM
State	:	NY
Zip	:	11580-5201
Country	:	US
Telephone Number	:	786-853-8863
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SAMUEL NELSON
Credential	:
Telephone Number	:	786-853-8863

Provider Enumeration Date	:	07/26/2017
Last Update Date	:	07/21/2022

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Directions to “PRIME LIVING CARE LLC ” Practice Location

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