Provider Demographics
NPI:1578696233
Name:PREMIER HOMECARE, LLC
Entity Type:Organization
Organization Name:PREMIER HOMECARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETH
Authorized Official - Middle Name:HATTON
Authorized Official - Last Name:JARDON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:828-396-9111
Mailing Address - Street 1:4096 HICKORY BLVD
Mailing Address - Street 2:
Mailing Address - City:GRANITE FALLS
Mailing Address - State:NC
Mailing Address - Zip Code:28630-8372
Mailing Address - Country:US
Mailing Address - Phone:828-396-9111
Mailing Address - Fax:828-396-9112
Practice Address - Street 1:4096 HICKORY BLVD
Practice Address - Street 2:
Practice Address - City:GRANITE FALLS
Practice Address - State:NC
Practice Address - Zip Code:28630-8372
Practice Address - Country:US
Practice Address - Phone:828-396-9111
Practice Address - Fax:828-396-9112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC3386376J00000X, 376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
Not Answered376K00000XNursing Service Related ProvidersNurse's AideGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3418171Medicaid