Provider Demographics
NPI:1962520221
Name:PRIMARY CARE NURSES HOME HEALTHCARE LLC
Entity type:Organization
Organization Name:PRIMARY CARE NURSES HOME HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAYNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:GOUDY-EGGER
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE PRACTITIONER
Authorized Official - Phone:586-779-3129
Mailing Address - Street 1:22777 HARPER AVE STE 103C
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080-1810
Mailing Address - Country:US
Mailing Address - Phone:586-779-3129
Mailing Address - Fax:586-779-3282
Practice Address - Street 1:22777 HARPER AVE STE 103C
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080-1810
Practice Address - Country:US
Practice Address - Phone:586-779-3129
Practice Address - Fax:586-779-3282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI237627Medicare ID - Type UnspecifiedHOME HEALTH AGENCY