Provider Demographics
NPI:1164807947
Name:PREMIERE SENIOR CARE, LLC
Entity Type:Organization
Organization Name:PREMIERE SENIOR CARE, LLC
Other - Org Name:A PREMIERE SENIOR CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:STACY
Authorized Official - Middle Name:LEN
Authorized Official - Last Name:WHETZELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-847-2422
Mailing Address - Street 1:PO BOX 770
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:GA
Mailing Address - Zip Code:30752-0770
Mailing Address - Country:US
Mailing Address - Phone:423-847-2422
Mailing Address - Fax:
Practice Address - Street 1:1700 BACK VALLEY RD
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:GA
Practice Address - Zip Code:30752-4641
Practice Address - Country:US
Practice Address - Phone:423-847-2422
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-22
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care