Provider Demographics
NPI:1225782543
Name:PREMIER HOME CARE SERVICE-EAST LLC
Entity Type:Organization
Organization Name:PREMIER HOME CARE SERVICE-EAST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXEC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DEKEISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:MATHIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-541-1495
Mailing Address - Street 1:6156 GREEN MEADOW PKWY
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-3347
Mailing Address - Country:US
Mailing Address - Phone:314-541-1495
Mailing Address - Fax:
Practice Address - Street 1:6156 GREEN MEADOW PKWY APT A
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209-3347
Practice Address - Country:US
Practice Address - Phone:314-541-1495
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-06
Last Update Date:2022-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health