Provider Demographics
NPI:1639216203
Name:1ST PREMIER HOME CARE, INC.
Entity Type:Organization
Organization Name:1ST PREMIER HOME CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:KAMINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MHA
Authorized Official - Phone:505-271-2120
Mailing Address - Street 1:PO BOX 51267
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87181-1267
Mailing Address - Country:US
Mailing Address - Phone:505-271-2120
Mailing Address - Fax:
Practice Address - Street 1:4411 MCLEOD RD NE
Practice Address - Street 2:SUITE G
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-2227
Practice Address - Country:US
Practice Address - Phone:505-271-2120
Practice Address - Fax:505-271-5316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3195251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMB4399Medicaid
NMD4068Medicaid