Provider Demographics
NPI:1326281379
Name:PREMIER CARE NURSES OF AMERICA
Entity Type:Organization
Organization Name:PREMIER CARE NURSES OF AMERICA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MIRJANA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOFORTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-353-9200
Mailing Address - Street 1:2799 NW BOCA RATON BLVD STE 204
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-6699
Mailing Address - Country:US
Mailing Address - Phone:561-353-9200
Mailing Address - Fax:561-353-9201
Practice Address - Street 1:2799 NW BOCA RATON BLVD STE 204
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-6699
Practice Address - Country:US
Practice Address - Phone:561-353-9200
Practice Address - Fax:561-353-9201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-07
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL30211191251E00000X
FL30211060251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health