- Enrollment id
- O20071129000261
- Enrollment state
- NY
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1841491412
- Multiple npi flag
- N
- Ccn
- 337190
- Associate id
- 5597854562
- Organization name
- PRIME HOME HEALTH SERVICES, LLC
- Incorporation date
- 2006-07-12
- Incorporation state
- NY
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 3125 EMMONS AVE
- City
- BROOKLYN
- State
- NY
- Zip code
- 112351724