1295184190 NPI number — A PREMIER SENIOR HOME CARE ACQUISITIONS, LLC

Table of content: (NPI 1295184190)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295184190 NPI number — A PREMIER SENIOR HOME CARE ACQUISITIONS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
A PREMIER SENIOR HOME CARE ACQUISITIONS, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295184190
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/22/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6760 OLD JACKSONVILLE HWY STE 101
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TYLER
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75703-0566
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
855-485-8273
Provider Business Mailing Address Fax Number:
405-835-6836

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
315 W CHOCTAW AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHICKASHA
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73018-2634
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
580-366-4237
Provider Business Practice Location Address Fax Number:
888-411-3004
Provider Enumeration Date:
06/10/2016

Additional Information

Authorized Official

Authorized Official Last Name:
LANIER
Authorized Official First Name:
KATRINA
Authorized Official Middle Name:
DAWN
Authorized Official Title or Position:
SECRETARY
Authorized Official Telephone Number:
855-485-8273

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  HC8015 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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