MEDICARE: PRIMARY HOUSECALL SERVICES, 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	251J00000X	Nursing Care Agency

General Provider Information

NPI Number	:	1386741411
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIMARY HOUSECALL SERVICES, LLC

Provider Business Mailing Address
First Line	:	2511 PALISADE DR
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46806-5316
Country	:	US
Telephone Number	:	260-447-4144
Fax Number	:	260-447-7860

Provider Business Practice Location Address
First Line	:	2511 PALISADE DR
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46806-5316
Country	:	US
Telephone Number	:	260-447-4144
Fax Number	:	260-447-7860

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	MRS. VONDA M LOVE
Credential	:	FNP-C
Telephone Number	:	260-447-4144

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	08/22/2020

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