Provider Demographics
NPI:1104212042
Name:PREMIER HOME HEALTH INDIANA, LLC
Entity Type:Organization
Organization Name:PREMIER HOME HEALTH INDIANA, LLC
Other - Org Name:ADORATION HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JONATHON
Authorized Official - Middle Name:TEVIS
Authorized Official - Last Name:WILDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-896-5782
Mailing Address - Street 1:11595 N MERIDIAN ST STE 515
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-6969
Mailing Address - Country:US
Mailing Address - Phone:317-983-1716
Mailing Address - Fax:317-983-1717
Practice Address - Street 1:11595 N MERIDIAN ST STE 515
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-6969
Practice Address - Country:US
Practice Address - Phone:317-983-1716
Practice Address - Fax:317-983-1717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-07
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health