Provider Demographics
NPI:1215593488
Name:PREMIER CARE OF OHIO, LLC.
Entity Type:Organization
Organization Name:PREMIER CARE OF OHIO, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF REVENUE CYCLE
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:GAITHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-248-8886
Mailing Address - Street 1:8444 N 90TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-4437
Mailing Address - Country:US
Mailing Address - Phone:480-494-2497
Mailing Address - Fax:480-687-7361
Practice Address - Street 1:42 E CRESCENTVILLE ROAD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45246
Practice Address - Country:US
Practice Address - Phone:513-671-7117
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PREMIER CARE OF OHIO, LLC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-05-14
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0077084Medicaid