Provider Demographics
NPI:1194445973
Name:PRIMIC PALLIATIVE HOSPICE CARE INC
Entity type:Organization
Organization Name:PRIMIC PALLIATIVE HOSPICE CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PRISCILLA
Authorized Official - Middle Name:
Authorized Official - Last Name:OMOLEME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-547-8312
Mailing Address - Street 1:11104 W AIRPORT BLVD STE 215C
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-3035
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11104 W AIRPORT BLVD STE 215C
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-3035
Practice Address - Country:US
Practice Address - Phone:240-547-8312
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-31
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251G00000XAgenciesHospice Care, Community BasedGroup - Single Specialty