Provider Demographics
NPI:1003219007
Name:PREMIER HOME HEALTH AGENCY
Entity Type:Organization
Organization Name:PREMIER HOME HEALTH AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:D
Authorized Official - Last Name:BLANCHART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-377-1004
Mailing Address - Street 1:3555 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86409-3011
Mailing Address - Country:US
Mailing Address - Phone:928-377-1004
Mailing Address - Fax:928-757-7179
Practice Address - Street 1:3555 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86409
Practice Address - Country:US
Practice Address - Phone:928-377-1004
Practice Address - Fax:928-757-7179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-03
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZHHA6631251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health