Provider Demographics
NPI:1962405530
Name:PRIME CARE HOME HEALTH SERVICES
Entity type:Organization
Organization Name:PRIME CARE HOME HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:AFZAL
Authorized Official - Middle Name:J
Authorized Official - Last Name:MALIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-769-6896
Mailing Address - Street 1:2632 W 81ST AVE
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-5235
Mailing Address - Country:US
Mailing Address - Phone:219-769-6896
Mailing Address - Fax:219-769-7032
Practice Address - Street 1:2632 W 81ST AVE
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-5235
Practice Address - Country:US
Practice Address - Phone:219-769-6896
Practice Address - Fax:219-769-7032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-27
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05-003155-1251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200399260AMedicaid
IN157543Medicare Oscar/Certification