Provider Demographics
NPI:1598454134
Name:PREMIER LIVING HOME CARE, LLC
Entity Type:Organization
Organization Name:PREMIER LIVING HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAWONA
Authorized Official - Middle Name:D
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-276-7692
Mailing Address - Street 1:5968 CLUBHOUSE DR
Mailing Address - Street 2:
Mailing Address - City:TRUSSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35173-3641
Mailing Address - Country:US
Mailing Address - Phone:205-276-7692
Mailing Address - Fax:
Practice Address - Street 1:5968 CLUBHOUSE DR
Practice Address - Street 2:
Practice Address - City:TRUSSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35173-3641
Practice Address - Country:US
Practice Address - Phone:205-276-7692
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-01
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care