Provider Demographics
NPI:1508167859
Name:PREMIERE CASE MANAGEMENT LLC
Entity Type:Organization
Organization Name:PREMIERE CASE MANAGEMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:MONIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:WINFREY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-263-1666
Mailing Address - Street 1:3430 E JEFFERSON AVE
Mailing Address - Street 2:644
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48207-4233
Mailing Address - Country:US
Mailing Address - Phone:313-263-1666
Mailing Address - Fax:313-447-2222
Practice Address - Street 1:3430 E JEFFERSON AVE
Practice Address - Street 2:644
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48207-4233
Practice Address - Country:US
Practice Address - Phone:313-263-1666
Practice Address - Fax:313-447-2222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-03
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization