Provider Demographics
NPI:1518332725
Name:PREMIER CARE SERVICES OF ENNIS, LLC
Entity Type:Organization
Organization Name:PREMIER CARE SERVICES OF ENNIS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VIVIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DURHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-875-6277
Mailing Address - Street 1:300 W CROCKETT ST
Mailing Address - Street 2:
Mailing Address - City:ENNIS
Mailing Address - State:TX
Mailing Address - Zip Code:75119-4704
Mailing Address - Country:US
Mailing Address - Phone:972-875-6277
Mailing Address - Fax:972-875-6276
Practice Address - Street 1:300 W CROCKETT ST
Practice Address - Street 2:
Practice Address - City:ENNIS
Practice Address - State:TX
Practice Address - Zip Code:75119-4704
Practice Address - Country:US
Practice Address - Phone:972-875-6277
Practice Address - Fax:972-875-6276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-14
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0169253747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty