Provider Demographics
NPI:1619230349
Name:PREMIER HEALTHCARE SERVICES, LLC
Entity Type:Organization
Organization Name:PREMIER HEALTHCARE SERVICES, LLC
Other - Org Name:AVEANNA HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR, REGULATORY LICENSING
Authorized Official - Prefix:
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITESIDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-248-8740
Mailing Address - Street 1:400 INTERSTATE NORTH PKWY SE STE 1600
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-5047
Mailing Address - Country:US
Mailing Address - Phone:770-248-8740
Mailing Address - Fax:626-204-7950
Practice Address - Street 1:1000 BURNETT AVE
Practice Address - Street 2:SUITE 435
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-2000
Practice Address - Country:US
Practice Address - Phone:925-356-3333
Practice Address - Fax:888-960-0957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-18
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health