Provider Demographics
NPI:1053637710
Name:PREMIER SERVICE OF CAROLINA, INC
Entity Type:Organization
Organization Name:PREMIER SERVICE OF CAROLINA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:WARNER
Authorized Official - Middle Name:
Authorized Official - Last Name:LEAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-985-1189
Mailing Address - Street 1:109 PENNY ST
Mailing Address - Street 2:
Mailing Address - City:ALBEMARLE
Mailing Address - State:NC
Mailing Address - Zip Code:28001-2803
Mailing Address - Country:US
Mailing Address - Phone:704-985-1178
Mailing Address - Fax:704-985-0106
Practice Address - Street 1:109 PENNY ST
Practice Address - Street 2:
Practice Address - City:ALBEMARLE
Practice Address - State:NC
Practice Address - Zip Code:28001
Practice Address - Country:US
Practice Address - Phone:704-985-1178
Practice Address - Fax:704-985-0106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-20
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
No251S00000XAgenciesCommunity/Behavioral Health