Provider Demographics
NPI:1467452748
Name:PREMIUM HOME HEALTH CARE INC
Entity Type:Organization
Organization Name:PREMIUM HOME HEALTH CARE INC
Other - Org Name:PREMIUM HOME HEALTH CARE INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRINIDAD
Authorized Official - Middle Name:CUEVAS
Authorized Official - Last Name:ALAIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-276-0604
Mailing Address - Street 1:2015 15 MILE RD
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-4864
Mailing Address - Country:US
Mailing Address - Phone:586-276-0604
Mailing Address - Fax:586-276-0614
Practice Address - Street 1:2015 15 MILE RD
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-4864
Practice Address - Country:US
Practice Address - Phone:586-276-0604
Practice Address - Fax:586-276-0614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3388986Medicaid
MI710100000E898OtherBLUE CROSS BLUE SHIELD
237424Medicare ID - Type Unspecified