Provider Demographics
NPI:1629391818
Name:PREMIER HEALTHCARE SERVICES, INC.
Entity Type:Organization
Organization Name:PREMIER HEALTHCARE SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:D
Authorized Official - Last Name:SURGEON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:1877-472-2302
Mailing Address - Street 1:1125 PONY DR
Mailing Address - Street 2:
Mailing Address - City:HOPE MILLS
Mailing Address - State:NC
Mailing Address - Zip Code:28348-9159
Mailing Address - Country:US
Mailing Address - Phone:877-472-2302
Mailing Address - Fax:850-515-0260
Practice Address - Street 1:1892 TURNPIKE RD
Practice Address - Street 2:
Practice Address - City:RAEFORD
Practice Address - State:NC
Practice Address - Zip Code:28376-8520
Practice Address - Country:US
Practice Address - Phone:877-472-2302
Practice Address - Fax:850-515-0260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-02
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty