Provider Demographics
NPI:1568668580
Name:PREMIUM HEALTH CARE, INC.
Entity Type:Organization
Organization Name:PREMIUM HEALTH CARE, INC.
Other - Org Name:HEBREW HOME OF SOUTH BEACH, ALF
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNWOODY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-672-6464
Mailing Address - Street 1:336 COLLINS AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33139-6903
Mailing Address - Country:US
Mailing Address - Phone:305-672-6464
Mailing Address - Fax:305-672-3243
Practice Address - Street 1:336 COLLINS AVE
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33139-6903
Practice Address - Country:US
Practice Address - Phone:305-672-6464
Practice Address - Fax:305-672-3243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-26
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL6700310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL140383400Medicaid