Provider Demographics
NPI:1356683650
Name:PREMIUM HEALTHCARE SERVICES LLC
Entity Type:Organization
Organization Name:PREMIUM HEALTHCARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BLASIUS
Authorized Official - Middle Name:
Authorized Official - Last Name:NGWA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-951-5770
Mailing Address - Street 1:2002 CREEKWAY DR
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75043-7568
Mailing Address - Country:US
Mailing Address - Phone:469-951-5770
Mailing Address - Fax:866-861-4181
Practice Address - Street 1:2002 CREEKWAY DR
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75043-7568
Practice Address - Country:US
Practice Address - Phone:469-951-5770
Practice Address - Fax:866-861-4181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-25
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health