Provider Demographics
NPI:1750939203
Name:PRIME HOME HEALTH GROUP INC
Entity type:Organization
Organization Name:PRIME HOME HEALTH GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:POLADYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-245-4402
Mailing Address - Street 1:1527 W MAGNOLIA BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91506-1835
Mailing Address - Country:US
Mailing Address - Phone:818-245-4402
Mailing Address - Fax:818-301-2332
Practice Address - Street 1:1527 W MAGNOLIA BLVD STE B
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91506-1835
Practice Address - Country:US
Practice Address - Phone:818-245-4402
Practice Address - Fax:818-301-2332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-28
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health