Provider Demographics
NPI:1114760782
Name:PRIME HEALTH GROUP AGENCY LLC
Entity type:Organization
Organization Name:PRIME HEALTH GROUP AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHERRICE
Authorized Official - Middle Name:
Authorized Official - Last Name:PATRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-321-2399
Mailing Address - Street 1:1601 E 18TH ST STE 206B
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64108-1680
Mailing Address - Country:US
Mailing Address - Phone:816-299-0285
Mailing Address - Fax:
Practice Address - Street 1:1601 E 18TH ST STE 206B
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64108-1680
Practice Address - Country:US
Practice Address - Phone:816-299-0285
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-13
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health