1912183880 NPI number — PREMIER HOME HEALTH CARE AGENCY

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912183880 NPI number — PREMIER HOME HEALTH CARE AGENCY

Organization/Personal Information

Employer Identification Number (EIN):
N/A
Provider Organization Name:
PREMIER HOME HEALTH CARE AGENCY
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:
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:
1912183880
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/10/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1298
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCKY MOUNT
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27802-1298
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-442-8040
Provider Business Mailing Address Fax Number:
252-451-8050

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
850 TIFFANY BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCKY MOUNT
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27804-1811
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-442-8040
Provider Business Practice Location Address Fax Number:
252-451-8050
Provider Enumeration Date:
01/10/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PARKER
Authorized Official First Name:
DANA
Authorized Official Middle Name:
Authorized Official Title or Position:
AGENCY DIRECTOR
Authorized Official Telephone Number:
252-442-8040

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  HC2881 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3408335 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".