Provider Demographics
NPI:1659631265
Name:PREMIER HEALTH AND WELLNESS CENTER
Entity Type:Organization
Organization Name:PREMIER HEALTH AND WELLNESS CENTER
Other - Org Name:PREMIER MEDICAL CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAM
Authorized Official - Middle Name:H
Authorized Official - Last Name:AWADA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-751-2020
Mailing Address - Street 1:30801 SCHOENHERR RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48088-6857
Mailing Address - Country:US
Mailing Address - Phone:586-751-2020
Mailing Address - Fax:586-751-7872
Practice Address - Street 1:30801 SCHOENHERR RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48088-6857
Practice Address - Country:US
Practice Address - Phone:586-751-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-17
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty