Provider Demographics
NPI:1225441561
Name:PREMIUM HOME HEALTH CARE, INC.
Entity Type:Organization
Organization Name:PREMIUM HOME HEALTH CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:FRANK
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:BSBA, CNA, CMA
Authorized Official - Phone:910-442-7297
Mailing Address - Street 1:102A S 12TH ST
Mailing Address - Street 2:
Mailing Address - City:ERWIN
Mailing Address - State:NC
Mailing Address - Zip Code:28339-2118
Mailing Address - Country:US
Mailing Address - Phone:910-442-7297
Mailing Address - Fax:
Practice Address - Street 1:102 A SOUTH 12TH STREET
Practice Address - Street 2:
Practice Address - City:ERWIN
Practice Address - State:NC
Practice Address - Zip Code:28339
Practice Address - Country:US
Practice Address - Phone:910-442-7297
Practice Address - Fax:910-897-2805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-04
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC422367251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health