Provider Demographics
NPI:1104287291
Name:PRIME HEALTHCARE GROUP
Entity type:Organization
Organization Name:PRIME HEALTHCARE GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:REED
Authorized Official - Middle Name:ISSAC
Authorized Official - Last Name:HAMILTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-502-3212
Mailing Address - Street 1:10057 LINCOLN RD
Mailing Address - Street 2:
Mailing Address - City:CAMP DENNISON
Mailing Address - State:OH
Mailing Address - Zip Code:45111-9736
Mailing Address - Country:US
Mailing Address - Phone:513-502-3212
Mailing Address - Fax:513-332-4433
Practice Address - Street 1:10057 LINCOLN RD
Practice Address - Street 2:
Practice Address - City:CAMP DENNISON
Practice Address - State:OH
Practice Address - Zip Code:45111-9736
Practice Address - Country:US
Practice Address - Phone:513-502-3212
Practice Address - Fax:513-332-4433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-16
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH201532300126253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care