Primordial Health Services LLC

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

Legal business name

PRIMORDIAL HEALTH SERVICES LLC

Practice address

1419 Northgate SQ Unit 12
Reston, VA 20190-3735

Phone

(571) 575-7174

NPI assigned

Oct 1, 2026

Last updated

Oct 1, 2026By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Caleb Hart

Title

Owner/Operator

Phone

(571) 575-7174

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1790812800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1790812800000",
    "number": "1972417236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1419 NORTHGATE SQ UNIT 12",
            "city": "RESTON",
            "state": "VA",
            "postal_code": "201903735"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1419 NORTHGATE SQ UNIT 12",
            "city": "RESTON",
            "state": "VA",
            "postal_code": "201903735",
            "telephone_number": "571-575-7174"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIMORDIAL HEALTH SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-10-01",
        "last_updated": "2026-10-01",
        "certification_date": "2026-10-01",
        "status": "A",
        "authorized_official_last_name": "HART",
        "authorized_official_first_name": "CALEB",
        "authorized_official_title_or_position": "OWNER/OPERATOR",
        "authorized_official_telephone_number": "571-575-7174"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.

Verify at the official NPI Registry.