Provider Demographics
NPI:1780197889
Name:SENIOR PREMIUM HOME CARE, LLC
Entity Type:Organization
Organization Name:SENIOR PREMIUM HOME CARE, LLC
Other - Org Name:VISITING ANGELS OF PENSACOLA & GULF BREEZE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:B
Authorized Official - Last Name:SWAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-377-2702
Mailing Address - Street 1:1550 CREIGHTON RD STE 8
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-9401
Mailing Address - Country:US
Mailing Address - Phone:850-377-2702
Mailing Address - Fax:850-435-4317
Practice Address - Street 1:1550 CREIGHTON RD STE 8
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-9401
Practice Address - Country:US
Practice Address - Phone:850-377-2702
Practice Address - Fax:850-435-4317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-10
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL299994790OtherHOME HEALTH AGENCY - NON MEDICAL