Provider Demographics
NPI:1821405986
Name:ML PREMIUM NURSING SERVICE
Entity Type:Organization
Organization Name:ML PREMIUM NURSING SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-899-8393
Mailing Address - Street 1:5376 STONE COVE DR SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-8917
Mailing Address - Country:US
Mailing Address - Phone:770-899-8393
Mailing Address - Fax:404-549-2450
Practice Address - Street 1:5376 STONE COVE DR SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-8917
Practice Address - Country:US
Practice Address - Phone:770-899-8393
Practice Address - Fax:404-549-2450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-21
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health