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Organization
PRIME HOME CARE LLC
Active
Organization
PRIME HOME CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICODHIA PAUL (CEO)
(561) 404-3519
Entity
Organization
Contact information
Practice address
1025 SW MARTIN DOWNS BLVD STE 206, PALM CITY, FL 34990-2864
(772) 600-3650
Mailing address
1025 SW MARTIN DOWNS BLVD STE 206, PALM CITY, FL 34990-2864
(772) 600-3650
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
NR30211877
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
810868688516
MEDICAID WAIVER
FL
Enumeration date
01/20/2017
Last updated
01/20/2017
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