Provider Demographics
NPI:1629513874
Name:PREMIUM CARE GROUP
Entity Type:Organization
Organization Name:PREMIUM CARE GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:V.P. OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DATHAN
Authorized Official - Last Name:BOOTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-638-5100
Mailing Address - Street 1:301 COMMERCE DR
Mailing Address - Street 2:
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057-4215
Mailing Address - Country:US
Mailing Address - Phone:856-638-5100
Mailing Address - Fax:856-642-1582
Practice Address - Street 1:301 COMMERCE DR
Practice Address - Street 2:
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057-4215
Practice Address - Country:US
Practice Address - Phone:856-638-5100
Practice Address - Fax:856-642-1582
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-27
Last Update Date:2016-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJHPO248300251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health