Provider Demographics
NPI:1902640683
Name:GEORGIA PRIME HOME CARE
Entity type:Organization
Organization Name:GEORGIA PRIME HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MUHAMED
Authorized Official - Middle Name:
Authorized Official - Last Name:RIZVANOVIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-956-1343
Mailing Address - Street 1:500 SUN VALLEY DR STE A1
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-1480
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:500 SUN VALLEY DR STE A1
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-1480
Practice Address - Country:US
Practice Address - Phone:678-956-1343
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-19
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health