Provider Demographics
NPI:1073607198
Name:PREMIER CARE LLC
Entity Type:Organization
Organization Name:PREMIER CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:614-431-0599
Mailing Address - Street 1:134 NORTHWOODS BLVD STE A2
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-4727
Mailing Address - Country:US
Mailing Address - Phone:614-431-0599
Mailing Address - Fax:614-431-0596
Practice Address - Street 1:134 NORTHWOODS BLVD STE A2
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43235-4727
Practice Address - Country:US
Practice Address - Phone:614-431-0599
Practice Address - Fax:614-431-0596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH367791251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2301306Medicaid
OH2301306Medicaid