Provider Demographics
NPI:1699040725
Name:PREMIUM IN-HOME CARE LLC
Entity Type:Organization
Organization Name:PREMIUM IN-HOME CARE LLC
Other - Org Name:PREMIUM IN-HOME CARE LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BASHEER
Authorized Official - Middle Name:
Authorized Official - Last Name:HAJI MOHAMMAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-827-9045
Mailing Address - Street 1:4065 S GRAND BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63118-3418
Mailing Address - Country:US
Mailing Address - Phone:314-827-9045
Mailing Address - Fax:314-657-0179
Practice Address - Street 1:4065 S GRAND BLVD STE 100
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63118-3418
Practice Address - Country:US
Practice Address - Phone:314-827-9045
Practice Address - Fax:314-657-0179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-22
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO251E00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care