Prominence Home Health Care Agency, LLC

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

Legal business name

PROMINENCE HOME HEALTH CARE AGENCY, LLC

Practice address

1800 Market St
Harrisburg, PA 17103-2523

Phone

(850) 691-7860

NPI assigned

Jun 14, 2019

Organization subpart

No

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

Authorized official

Name

Mr. Freddie L. Fagan Jr.

Title

Chief Executive Officer

Phone

(850) 691-7860

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1560470400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1592956800000",
    "number": "1568022283",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1800 MARKET ST",
            "city": "HARRISBURG",
            "state": "PA",
            "postal_code": "171032523",
            "telephone_number": "850-691-7860"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1800 MARKET ST",
            "city": "HARRISBURG",
            "state": "PA",
            "postal_code": "171032523",
            "telephone_number": "850-691-7860"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROMINENCE HOME HEALTH CARE AGENCY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-14",
        "last_updated": "2020-06-24",
        "certification_date": "2020-06-24",
        "status": "A",
        "authorized_official_last_name": "FAGAN",
        "authorized_official_first_name": "FREDDIE",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "850-691-7860",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PENNSYLVANIA DEPARTMENT OF HEALTH CERTIFICATE OF LICENSURE",
            "identifier": "48703601",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2020; 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.