Provider Demographics
NPI:1043828932
Name:PRIMARY MEDICAL HOMECARE LLC
Entity type:Organization
Organization Name:PRIMARY MEDICAL HOMECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTHCARE ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:REDA
Authorized Official - Middle Name:
Authorized Official - Last Name:COSTON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD/PHD
Authorized Official - Phone:404-800-5550
Mailing Address - Street 1:2480 WINDY HILL RD SE STE 206
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-8656
Mailing Address - Country:US
Mailing Address - Phone:404-800-5550
Mailing Address - Fax:
Practice Address - Street 1:2480 WINDY HILL RD SE STE 206
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-8656
Practice Address - Country:US
Practice Address - Phone:404-800-5550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRIMARY MEDICAL HOMECARE 'PMH' LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-07-17
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Multi-Specialty
No163WC0400XNursing Service ProvidersRegistered NurseCase ManagementGroup - Multi-Specialty
No177F00000XOther Service ProvidersLodging
No251B00000XAgenciesCase Management
No251F00000XAgenciesHome Infusion
No251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care
No291U00000XLaboratoriesClinical Medical Laboratory
No347C00000XTransportation ServicesPrivate VehicleGroup - Multi-Specialty
No374700000XNursing Service Related ProvidersTechnicianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA033-R-1687OtherDEPT. OF COMMUNITY HEALTH