Provider Demographics
NPI:1629467998
Name:PREMIUM HOME HEALTHCARE LLC
Entity Type:Organization
Organization Name:PREMIUM HOME HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:GIBLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-969-6292
Mailing Address - Street 1:100 CUMMINGS CENTER DRIVE
Mailing Address - Street 2:SUITE 325-C
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-1310
Mailing Address - Country:US
Mailing Address - Phone:978-969-6292
Mailing Address - Fax:978-998-4523
Practice Address - Street 1:100 CUMMINGS CTR
Practice Address - Street 2:SUITE 325-C
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-6115
Practice Address - Country:US
Practice Address - Phone:978-969-6292
Practice Address - Fax:978-998-4523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-09
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health