MEDICARE: PRIMARY HOMECARE, 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	363LG0600X	Gerontology Nurse Practitioner
2	363LP2300X	Primary Care Nurse Practitioner

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629023593
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIMARY HOMECARE, LLC

Provider Business Mailing Address
First Line	:	8118 OLD YORK RD
Second Line	:	SUITE D
City	:	ELKINS PARK
State	:	PA
Zip	:	19027-1423
Country	:	US
Telephone Number	:	215-635-3151
Fax Number	:	215-635-3165

Provider Business Practice Location Address
First Line	:	8118 OLD YORK RD
Second Line	:	SUITE D
City	:	ELKINS PARK
State	:	PA
Zip	:	19027-1423
Country	:	US
Telephone Number	:	215-635-3151
Fax Number	:	215-635-3165

Authorized Official
Title or Position	:	CCO
Name	:	LISA GILL
Credential	:	DNP, CRNP
Telephone Number	:	215-635-3151

Provider Enumeration Date	:	05/22/2006
Last Update Date	:	02/15/2023

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Directions to “PRIMARY HOMECARE, LLC ” Practice Location

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