Provider Demographics
NPI:1841790102
Name:PREMIER CARE ASSISTED LIVING
Entity Type:Organization
Organization Name:PREMIER CARE ASSISTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DONZELL
Authorized Official - Middle Name:JUNIOR
Authorized Official - Last Name:DAWKINS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:989-295-7641
Mailing Address - Street 1:1109 16TH ST
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48708-7334
Mailing Address - Country:US
Mailing Address - Phone:989-295-7641
Mailing Address - Fax:989-496-0147
Practice Address - Street 1:1109 16TH ST
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48708-7334
Practice Address - Country:US
Practice Address - Phone:989-295-7641
Practice Address - Fax:989-496-0147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-13
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency