Provider Demographics
NPI:1518564699
Name:PREMIER CARE CENTRE LLC
Entity Type:Organization
Organization Name:PREMIER CARE CENTRE LLC
Other - Org Name:FAMILY HOLISTIC WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DNP, APRN
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTA
Authorized Official - Middle Name:
Authorized Official - Last Name:LORGEAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-250-7260
Mailing Address - Street 1:2050 HAVENDALE BLVD NW STE B
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33881-3828
Mailing Address - Country:US
Mailing Address - Phone:863-268-2211
Mailing Address - Fax:863-222-9343
Practice Address - Street 1:2050 HAVENDALE BLVD NW STE B
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33881-3828
Practice Address - Country:US
Practice Address - Phone:863-268-2211
Practice Address - Fax:863-222-9343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-02
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1336571116Medicaid