Provider Demographics
NPI:1659090595
Name:PREMIUM PERSONAL HOME CARE LLC
Entity Type:Organization
Organization Name:PREMIUM PERSONAL HOME CARE LLC
Other - Org Name:PREMIUM PERSONAL HOME CARE LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:OSLEIDIS
Authorized Official - Middle Name:PEREZ
Authorized Official - Last Name:LAGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:432-556-7841
Mailing Address - Street 1:3801 N COUNTY ROAD 1140
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79705-9609
Mailing Address - Country:US
Mailing Address - Phone:432-270-6074
Mailing Address - Fax:432-260-6077
Practice Address - Street 1:3801 N COUNTY ROAD 1140
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79705-9609
Practice Address - Country:US
Practice Address - Phone:432-270-6074
Practice Address - Fax:432-260-6077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-24
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive CareGroup - Single Specialty