1083625156 NPI number — PREMIER HOME CARE, INC

Table of content: (NPI 1083625156)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083625156 NPI number — PREMIER HOME CARE, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PREMIER HOME CARE, INC
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:
1083625156
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/14/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3325 BARTLETT BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORLANDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32811-6428
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-206-0040
Provider Business Mailing Address Fax Number:
407-206-0010

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
404 S MAYO TRL
Provider Second Line Business Practice Location Address:
STE 9
Provider Business Practice Location Address City Name:
PIKEVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-437-5562
Provider Business Practice Location Address Fax Number:
606-437-5527
Provider Enumeration Date:
08/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GRIGGS
Authorized Official First Name:
STEPHEN
Authorized Official Middle Name:
P
Authorized Official Title or Position:
CEO / PRESIDENT
Authorized Official Telephone Number:
407-206-0040

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BX2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000000506316 . This is a "ANTHEM ID" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: MG0571 . This is a "KENTUCKY BOARD OF PHARMACY LICENSE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 7100035190 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 400030 . This is a "BLACK LUNG" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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