Provider Demographics
NPI:1508969536
Name:PREMIER TOTAL HEALTHCARE INC
Entity Type:Organization
Organization Name:PREMIER TOTAL HEALTHCARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSSANA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:DICARLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-456-0250
Mailing Address - Street 1:1250 E HALLANDALE BEACH BLVD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-4634
Mailing Address - Country:US
Mailing Address - Phone:954-456-0250
Mailing Address - Fax:954-456-0820
Practice Address - Street 1:1250 E HALLANDALE BEACH BLVD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-4634
Practice Address - Country:US
Practice Address - Phone:954-456-0250
Practice Address - Fax:954-456-0820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7202111N00000X
FLOS5537207Q00000X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDD8449OtherRAILROAD MEDICARE
FL45321OtherBC/BS OF FL GROUP#
FLDD8449OtherRAILROAD MEDICARE