Provider Demographics
NPI:1710210430
Name:PREMIER COMMUNITY SERVICES, LLC
Entity Type:Organization
Organization Name:PREMIER COMMUNITY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:225-933-0142
Mailing Address - Street 1:PO BOX 1009
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:LA
Mailing Address - Zip Code:70514-1009
Mailing Address - Country:US
Mailing Address - Phone:337-269-8990
Mailing Address - Fax:225-272-1940
Practice Address - Street 1:3414 MOSS ST
Practice Address - Street 2:SUITE G
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70507-6107
Practice Address - Country:US
Practice Address - Phone:337-269-8990
Practice Address - Fax:225-272-1940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-14
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15118251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services