Provider Demographics
NPI:1477705341
Name:PREMIER HOME HEALTH PROVIDERS INC.
Entity Type:Organization
Organization Name:PREMIER HOME HEALTH PROVIDERS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DWIGHT
Authorized Official - Middle Name:
Authorized Official - Last Name:LUBRIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-286-1199
Mailing Address - Street 1:1095 BIRD AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95125-1640
Mailing Address - Country:US
Mailing Address - Phone:408-286-1199
Mailing Address - Fax:408-519-6226
Practice Address - Street 1:1095 BIRD AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95125-1640
Practice Address - Country:US
Practice Address - Phone:408-286-1199
Practice Address - Fax:408-519-6226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-22
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA059180Medicare Oscar/Certification