MEDICARE: PRIME HEALTHCARE SERVICES

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	:	1982174553
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIME HEALTHCARE SERVICES

Provider Business Mailing Address
First Line	:	2336 JOHN MCMILLAN RD
Second Line	:
City	:	HOPE MILLS
State	:	NC
Zip	:	28348
Country	:	US
Telephone Number	:	980-208-8366
Fax Number	:

Provider Business Practice Location Address
First Line	:	2336 JOHN MCMILLAN RD
Second Line	:
City	:	HOPE MILLS
State	:	NC
Zip	:	28348
Country	:	US
Telephone Number	:	980-208-8366
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	GABRIEL ROSS
Credential	:
Telephone Number	:	980-208-8366

Provider Enumeration Date	:	11/27/2018
Last Update Date	:	11/27/2018

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