Provider Demographics
NPI:1417505124
Name:PREMIEANT INC
Entity Type:Organization
Organization Name:PREMIEANT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:ENGELKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-916-1632
Mailing Address - Street 1:1110 W WILLIAM CANNON DR BLDG 2
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-5468
Mailing Address - Country:US
Mailing Address - Phone:512-916-1632
Mailing Address - Fax:512-916-1639
Practice Address - Street 1:12427 AUTUMN VISTA ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249-2407
Practice Address - Country:US
Practice Address - Phone:512-916-1632
Practice Address - Fax:512-916-1639
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PREMIEANT INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-08-27
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1235240300Medicaid
TX1326141789Medicaid
TX1407967573Medicaid
TX1124139340Medicaid
TX1144323502Medicaid
TX1467563536Medicaid
TX1871604934Medicaid
TX1962505321Medicaid
TX1871696237Medicaid
TX1396856514Medicaid
TX1235232695Medicaid