Provider Demographics
NPI:1477918985
Name:PREMIER INTEGRATED CARE LLC
Entity Type:Organization
Organization Name:PREMIER INTEGRATED CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIE-CHANTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:GHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-644-1973
Mailing Address - Street 1:15032 CHERRYWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-5548
Mailing Address - Country:US
Mailing Address - Phone:202-644-1937
Mailing Address - Fax:
Practice Address - Street 1:15032 CHERRYWOOD DR
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-5548
Practice Address - Country:US
Practice Address - Phone:202-644-1937
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-28
Last Update Date:2015-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities