Provider Demographics
NPI:1710651872
Name:PREMIER SERVICE OF CAROLINA, INC
Entity Type:Organization
Organization Name:PREMIER SERVICE OF CAROLINA, INC
Other - Org Name:PREMIER SERVICE OF CAROLINA INC
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:WARNER
Authorized Official - Middle Name:
Authorized Official - Last Name:LEAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-985-1189
Mailing Address - Street 1:929 CONCORD PKWY S STE K
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-5031
Mailing Address - Country:US
Mailing Address - Phone:704-985-1189
Mailing Address - Fax:
Practice Address - Street 1:929 CONCORD PKWY S STE K
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-5031
Practice Address - Country:US
Practice Address - Phone:704-985-1189
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-03
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health