Provider Demographics
NPI:1659360501
Name:PREMIER HOME HEALTHCARE, INC
Entity Type:Organization
Organization Name:PREMIER HOME HEALTHCARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:B
Authorized Official - Last Name:BATES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-228-4661
Mailing Address - Street 1:2454 E MICHIGAN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-5059
Mailing Address - Country:US
Mailing Address - Phone:407-228-4661
Mailing Address - Fax:407-895-1261
Practice Address - Street 1:2454 E MICHIGAN ST
Practice Address - Street 2:SUITE B
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-5059
Practice Address - Country:US
Practice Address - Phone:407-228-4661
Practice Address - Fax:407-895-1261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-13
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL424332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLR8906OtherBC/BS #
FL022630100Medicaid
FL022630100Medicaid