Provider Demographics
NPI:1619990595
Name:PREMIER CARE HOMECARE, LLC
Entity Type:Organization
Organization Name:PREMIER CARE HOMECARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:BAHAA
Authorized Official - Middle Name:REFAT
Authorized Official - Last Name:GERGES
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:352-365-7850
Mailing Address - Street 1:1218 W DIXIE AVE STE B
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-6380
Mailing Address - Country:US
Mailing Address - Phone:352-365-7850
Mailing Address - Fax:352-365-7856
Practice Address - Street 1:1218 W DIXIE AVE STE B
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-6380
Practice Address - Country:US
Practice Address - Phone:352-365-7850
Practice Address - Fax:352-365-7856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X
FL299992468251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL108410Medicare Oscar/Certification