Provider Demographics
NPI:1104409002
Name:PRIME HOME CARE INC
Entity type:Organization
Organization Name:PRIME HOME CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PAULINE
Authorized Official - Middle Name:
Authorized Official - Last Name:KUKUNDA KYAMBADE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-325-3605
Mailing Address - Street 1:100 POWDERMILL RD STE 173
Mailing Address - Street 2:
Mailing Address - City:ACTON
Mailing Address - State:MA
Mailing Address - Zip Code:01720-5932
Mailing Address - Country:US
Mailing Address - Phone:781-325-3605
Mailing Address - Fax:
Practice Address - Street 1:24 CRESCENT ST STE 307
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02453-4360
Practice Address - Country:US
Practice Address - Phone:781-325-3605
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-29
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health