MEDICARE: PRIME HOME 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	374U00000X	Home Health Aide
2	251E00000X	Home Health Agency

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

General Provider Information

NPI Number	:	1740933746
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIME HOME CARE LLC

Provider Business Mailing Address
First Line	:	7157 W OAKLAND PARK BLVD
Second Line	:
City	:	LAUDERHILL
State	:	FL
Zip	:	33313-1038
Country	:	US
Telephone Number	:	954-520-7005
Fax Number	:	772-600-3651

Provider Business Practice Location Address
First Line	:	7157 W OAKLAND PARK BLVD
Second Line	:
City	:	LAUDERHILL
State	:	FL
Zip	:	33313-1038
Country	:	US
Telephone Number	:	954-520-7005
Fax Number	:	772-600-3651

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	NICODHIA PAUL
Credential	:	MHA
Telephone Number	:	561-705-1212

Provider Enumeration Date	:	01/31/2022
Last Update Date	:	01/31/2022

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Directions to “PRIME HOME CARE LLC ” Practice Location

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