Provider Demographics
NPI:1821354630
Name:PREMIER PERSONAL HEALTH SERVICES, LLC
Entity Type:Organization
Organization Name:PREMIER PERSONAL HEALTH SERVICES, LLC
Other - Org Name:PREMIER PRIVATE HOME CARE AGENCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:YVONNE
Authorized Official - Last Name:BRADSHAW-SMALL
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, BC
Authorized Official - Phone:866-447-4547
Mailing Address - Street 1:6269 GREENOCK DR
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30087-6081
Mailing Address - Country:US
Mailing Address - Phone:866-446-4547
Mailing Address - Fax:678-825-6030
Practice Address - Street 1:6269 GREENOCK DR
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30087-6081
Practice Address - Country:US
Practice Address - Phone:866-446-4547
Practice Address - Fax:678-825-6030
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PREMIER PERSONAL HEALTH SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-04-05
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No251S00000XAgenciesCommunity/Behavioral Health
No253Z00000XAgenciesIn Home Supportive Care