Provider Demographics
NPI:1215588959
Name:PREMIEANT INC
Entity Type:Organization
Organization Name:PREMIEANT INC
Other - Org Name:MAPLETREE HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:ENGELKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-916-1632
Mailing Address - Street 1:1110 W WILLIAM CANNON DR BLDG 2
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-5468
Mailing Address - Country:US
Mailing Address - Phone:512-916-1632
Mailing Address - Fax:512-916-1639
Practice Address - Street 1:12342 MAPLETREE ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249-2429
Practice Address - Country:US
Practice Address - Phone:210-525-1509
Practice Address - Fax:210-979-8047
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PREMIEANT INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-09-24
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities