Provider Demographics
NPI:1609412147
Name:PREMIER HEALTH ACADEMY, LLC
Entity Type:Organization
Organization Name:PREMIER HEALTH ACADEMY, LLC
Other - Org Name:PHA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHOISETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:DAMUS
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:407-955-2324
Mailing Address - Street 1:3050 DYER BLVD # 144
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-7839
Mailing Address - Country:US
Mailing Address - Phone:407-955-2324
Mailing Address - Fax:407-750-6618
Practice Address - Street 1:3033 CARDILLINO WAY
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-7851
Practice Address - Country:US
Practice Address - Phone:321-900-6791
Practice Address - Fax:407-201-6618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-19
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty