Prime Home Health Group Inc

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

Legal business name

PRIME HOME HEALTH GROUP INC

Practice address

1527 W Magnolia Blvd Ste B
Burbank, CA 91506-1835

Phone

(818) 245-4402

Fax

(818) 301-2332

NPI assigned

Aug 28, 2019

Organization subpart

No

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

Authorized official

Name

Christina Poladyan

Title

Ceo

Phone

(818) 245-4402

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Home health agency certification: CCN 757793

Legal name

PRIME HOME HEALTH GROUP INC

Certification status

Active

Provider type (POS)

Home health agency

Participating since

Oct 18, 2024

Last certification

Oct 18, 2024

Organization structure

CorporationProprietary

Enrollment address

19634 Ventura Blvd
Ste 204
Tarzana, CA 91356-2992

Listed as

Prime Home Health Group, IncCCN 757793

Ownership

-

Certified

Oct 18, 2024

Medicare certification status

ActiveFrom the Provider of Services file

Locations

All disclosed owners & managing parties 2

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

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

{
    "created_epoch": "1566950400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1566950400000",
    "number": "1750939203",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1527 W MAGNOLIA BLVD STE B",
            "city": "BURBANK",
            "state": "CA",
            "postal_code": "915061835",
            "telephone_number": "818-245-4402",
            "fax_number": "818-301-2332"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1527 W MAGNOLIA BLVD STE B",
            "city": "BURBANK",
            "state": "CA",
            "postal_code": "915061835",
            "telephone_number": "818-245-4402",
            "fax_number": "818-301-2332"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIME HOME HEALTH GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-08-28",
        "last_updated": "2019-08-28",
        "status": "A",
        "authorized_official_last_name": "POLADYAN",
        "authorized_official_first_name": "CHRISTINA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "818-245-4402"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Home Health Agency in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.