MEDICARE: PRIME CARE HOME 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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1679938203
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIME CARE HOME SERVICES LLC

Provider Business Mailing Address
First Line	:	11 DEAN DR
Second Line	:
City	:	LOWELL
State	:	MA
Zip	:	01854-1491
Country	:	US
Telephone Number	:	781-428-3141
Fax Number	:

Provider Business Practice Location Address
First Line	:	140 WOOD RD STE 1007
Second Line	:
City	:	BRAINTREE
State	:	MA
Zip	:	02184-2507
Country	:	US
Telephone Number	:	781-428-3141
Fax Number	:	781-428-3183

Authorized Official
Title or Position	:	CEO
Name	:	MISS PENINNAH W MUIRURI
Credential	:
Telephone Number	:	781-428-3141

Provider Enumeration Date	:	12/26/2015
Last Update Date	:	01/06/2016

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