Provider Demographics
NPI:1376180646
Name:PREMIERE FAMILY SERVICES, LLC
Entity Type:Organization
Organization Name:PREMIERE FAMILY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BURTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-485-1160
Mailing Address - Street 1:3108 N PARHAM RD STE 500B
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23294-4418
Mailing Address - Country:US
Mailing Address - Phone:804-485-1160
Mailing Address - Fax:804-344-3277
Practice Address - Street 1:3108 N PARHAM RD STE 500B
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23294-4418
Practice Address - Country:US
Practice Address - Phone:804-485-1160
Practice Address - Fax:804-477-3244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-05
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health