# PRIME VIDA HOME SUPPORT CORP

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1316896442
- **Authorized official:** JORGE E FERNANDEZ CALANA (OWNER)
- **Authorized official phone:** (305) 924-3220

## Contact information

- **Practice address:** 3912 W 12TH AVE, HIALEAH, FL 33012-4105
- **Practice address phone:** (754) 345-7001
- **Mailing address:** 3912 W 12TH AVE, HIALEAH, FL 33012-4105
- **Mailing address phone:** (754) 345-7001

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 253Z00000X | In Home Supportive Care Agency | — | NULL | Yes |

## Other

- **Enumeration date:** 01/22/2026
- **Last updated:** 01/22/2026