Provider Demographics
NPI:1467082396
Name:PREMIER SERVICE OF CAROLINA, INC
Entity Type:Organization
Organization Name:PREMIER SERVICE OF CAROLINA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CEO
Authorized Official - Prefix:
Authorized Official - First Name:WARNER
Authorized Official - Middle Name:
Authorized Official - Last Name:LEAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-985-1189
Mailing Address - Street 1:510 W KING ST
Mailing Address - Street 2:
Mailing Address - City:KINGS MOUNTAIN
Mailing Address - State:NC
Mailing Address - Zip Code:28086-3310
Mailing Address - Country:US
Mailing Address - Phone:704-985-1189
Mailing Address - Fax:
Practice Address - Street 1:510 W KING ST
Practice Address - Street 2:
Practice Address - City:KINGS MOUNTAIN
Practice Address - State:NC
Practice Address - Zip Code:28086-3310
Practice Address - Country:US
Practice Address - Phone:704-985-1189
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PREMIER SERVICE OF CAROLINA, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-01-20
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health