Provider Demographics
NPI:1740800366
Name:PREMIER INNOVATIVE CARE SERVICES
Entity Type:Organization
Organization Name:PREMIER INNOVATIVE CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:HILLSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-296-7957
Mailing Address - Street 1:525 E CAMELBACK RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-1615
Mailing Address - Country:US
Mailing Address - Phone:602-296-7957
Mailing Address - Fax:
Practice Address - Street 1:525 E CAMELBACK RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-1615
Practice Address - Country:US
Practice Address - Phone:602-296-7957
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-23
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty