# PRIMARY MEDICAL HOMECARE LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** HomeCare Dispatch PMH LLC Agency
- **Organization subpart:** No

## Provider details

- **NPI number:** 1750763132
- **Authorized official:** DR. R. COSTON PSY.D/PH.D (CEO)
- **Authorized official phone:** (855) 525-1000

## Contact information

- **Practice address:** 2480 WINDY HILL RD SE, SUITE 206, MARIETTA, GA 30067-8644
- **Practice address phone:** (855) 525-1000
- **Practice address fax:** (855) 525-1056
- **Mailing address:** 2480 WINDY HILL RD SE, SUITE 206, MARIETTA, GA 30067-8644
- **Mailing address phone:** (855) 525-1000
- **Mailing address fax:** (855) 525-1056

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251F00000X | Home Infusion Agency | 033-R-1687 | GA | — |
| 253Z00000X | In Home Supportive Care Agency | CN0028882028 | GA | Yes |
| 305S00000X | Point of Service | 68372 | GA | — |
| 332BN1400X | Nursing Facility Supplies (DME) | CN0028882028 | GA | — |
| 343800000X | Secured Medical Transport (VAN) | — | GA | — |

## Other

- **Enumeration date:** 06/23/2015
- **Last updated:** 07/21/2022