Provider Demographics
NPI:1659164374
Name:COLONIAL PRIME HOME CARE LLC
Entity type:Organization
Organization Name:COLONIAL PRIME HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ADMINISTRATOR/MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:MANGE
Authorized Official - Last Name:KIVIHYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-309-7395
Mailing Address - Street 1:17 HAMPDEN ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01103-1262
Mailing Address - Country:US
Mailing Address - Phone:413-306-3535
Mailing Address - Fax:
Practice Address - Street 1:17 HAMPDEN ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01103-1262
Practice Address - Country:US
Practice Address - Phone:413-306-3535
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-26
Last Update Date:2025-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251B00000XAgenciesCase Management
No251J00000XAgenciesNursing Care