Provider Demographics
NPI:1821239203
Name:PREMIER COMMUNITY SERVICES
Entity Type:Organization
Organization Name:PREMIER COMMUNITY SERVICES
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:LCSW
Authorized Official - Phone:225-405-3333
Mailing Address - Street 1:3414 MOSS ST
Mailing Address - Street 2:STE C
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70507-6107
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:STE C
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:2009-03-16
Last Update Date:2009-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPCA15118251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1329215Medicaid