Provider Demographics
NPI:1538561121
Name:1ST PRIME HOME HEALTH SERVICES, LLC
Entity type:Organization
Organization Name:1ST PRIME HOME HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:DOUGLAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-822-6542
Mailing Address - Street 1:1900 N. MACARTHUR BLVD
Mailing Address - Street 2:SUITE 116
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73127-0000
Mailing Address - Country:US
Mailing Address - Phone:405-822-6542
Mailing Address - Fax:405-601-0948
Practice Address - Street 1:1900 N MACARTHUR BLVD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73127-2617
Practice Address - Country:US
Practice Address - Phone:405-822-6542
Practice Address - Fax:405-601-0948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-25
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7831251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health