Provider Demographics
NPI:1629769682
Name:PREMIER PLUS COMMUNITY LIVING LLC
Entity Type:Organization
Organization Name:PREMIER PLUS COMMUNITY LIVING LLC
Other - Org Name:PREMIER PLUS COMMUNITY LIVING LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PRINCE
Authorized Official - Middle Name:AFARI
Authorized Official - Last Name:BOATENG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-455-3385
Mailing Address - Street 1:4008 GENESEE PL STE 105
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-8306
Mailing Address - Country:US
Mailing Address - Phone:703-455-3385
Mailing Address - Fax:703-580-9308
Practice Address - Street 1:4008 GENESEE PL STE 105
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-8306
Practice Address - Country:US
Practice Address - Phone:703-455-3385
Practice Address - Fax:703-580-9308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-18
Last Update Date:2023-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home