Provider Demographics
NPI:1326405432
Name:MICHIGAN PREMIER PRIVATE DUTY, LLC
Entity Type:Organization
Organization Name:MICHIGAN PREMIER PRIVATE DUTY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JABEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BUKHARI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-345-0021
Mailing Address - Street 1:312 E HOUGHTON AVE
Mailing Address - Street 2:
Mailing Address - City:WEST BRANCH
Mailing Address - State:MI
Mailing Address - Zip Code:48661-1186
Mailing Address - Country:US
Mailing Address - Phone:989-345-0021
Mailing Address - Fax:989-345-0055
Practice Address - Street 1:312 E HOUGHTON AVE
Practice Address - Street 2:
Practice Address - City:WEST BRANCH
Practice Address - State:MI
Practice Address - Zip Code:48661-1186
Practice Address - Country:US
Practice Address - Phone:989-345-0021
Practice Address - Fax:989-345-0055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-20
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care