Prime Providers Id LLC

Primary specialty

In Home Supportive Care AgencyTaxonomy code 253Z00000X

Legal business name

PRIME PROVIDERS ID LLC

Practice address

950 W Bannock St Ste 1100
Boise, ID 83702-6140

Phone

(208) 900-6330

NPI assigned

Dec 16, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jonathan Sassover

Title

Authorized Signatory

Phone

(818) 377-6202

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1671148800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1671148800000",
    "number": "1063124428",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4200 SEPULVEDA BLVD STE 101",
            "city": "CULVER CITY",
            "state": "CA",
            "postal_code": "902304742"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "950 W BANNOCK ST STE 1100",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837026140",
            "telephone_number": "208-900-6330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIME PROVIDERS ID LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-12-16",
        "last_updated": "2022-12-16",
        "certification_date": "2022-12-16",
        "status": "A",
        "authorized_official_last_name": "SASSOVER",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_title_or_position": "AUTHORIZED SIGNATORY",
        "authorized_official_telephone_number": "818-377-6202"
    },
    "taxonomies": [
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• In Home Supportive Care Agency in Boise, ID
• Providers in Boise, ID by specialty
• In Home Supportive Care Agency in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.