Provider Demographics
NPI:1518275767
Name:PREMIER HOME CARE, INC
Entity Type:Organization
Organization Name:PREMIER HOME CARE, INC
Other - Org Name:PREMIER THERAPIES DBA PREMIER HOME CARE INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LAWANNA
Authorized Official - Middle Name:LOU
Authorized Official - Last Name:BEST
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:719-395-3124
Mailing Address - Street 1:PO BOX 5007
Mailing Address - Street 2:301 HWY 24 N
Mailing Address - City:BUENA VISTA
Mailing Address - State:CO
Mailing Address - Zip Code:81211-5007
Mailing Address - Country:US
Mailing Address - Phone:719-395-3124
Mailing Address - Fax:719-395-3128
Practice Address - Street 1:301 HWY 24 N
Practice Address - Street 2:
Practice Address - City:BUENA VISTA
Practice Address - State:CO
Practice Address - Zip Code:81211
Practice Address - Country:US
Practice Address - Phone:719-395-3124
Practice Address - Fax:719-395-3128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-22
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
163WH0200X
CO8425261QP2000X
IL160003053261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1114949609OtherHOME HEALTH AGENCY