Provider Demographics
NPI:1750763132
Name:PRIMARY MEDICAL HOMECARE LLC
Entity type:Organization
Organization Name:PRIMARY MEDICAL HOMECARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:R.
Authorized Official - Middle Name:
Authorized Official - Last Name:COSTON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD/PHD
Authorized Official - Phone:855-525-1000
Mailing Address - Street 1:2480 WINDY HILL RD SE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-8644
Mailing Address - Country:US
Mailing Address - Phone:855-525-1000
Mailing Address - Fax:855-525-1056
Practice Address - Street 1:2480 WINDY HILL RD SE
Practice Address - Street 2:SUITE 206
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-8644
Practice Address - Country:US
Practice Address - Phone:855-525-1000
Practice Address - Fax:855-525-1056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA68372305S00000X
GACN0028882028332BN1400X, 253Z00000X
GA343800000X
GA033-R-1687251F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No305S00000XManaged Care OrganizationsPoint of Service
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
No343800000XTransportation ServicesSecured Medical Transport (VAN)
No251F00000XAgenciesHome Infusion