Provider Demographics
NPI:1417216920
Name:PREMIUM HEALTHCARE SERVICES, LLC
Entity Type:Organization
Organization Name:PREMIUM HEALTHCARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CLINICAL SERVICES
Authorized Official - Prefix:MRS
Authorized Official - First Name:ETHEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:FREEMAN-NNONAH
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:614-501-3034
Mailing Address - Street 1:2244 S HAMILTON RD STE 104
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43232-4483
Mailing Address - Country:US
Mailing Address - Phone:614-501-3034
Mailing Address - Fax:
Practice Address - Street 1:2244 S HAMILTON RD
Practice Address - Street 2:SUITE 104
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43232-4390
Practice Address - Country:US
Practice Address - Phone:614-501-3034
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-04
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health