Provider Demographics
NPI:1871841114
Name:PREMIER THERAPY CARE
Entity Type:Organization
Organization Name:PREMIER THERAPY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-940-6613
Mailing Address - Street 1:330 EASTERN BYP
Mailing Address - Street 2:SUITE 145
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-2562
Mailing Address - Country:US
Mailing Address - Phone:859-940-6613
Mailing Address - Fax:
Practice Address - Street 1:330 EASTERN BYP
Practice Address - Street 2:SUITE 145
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-2562
Practice Address - Country:US
Practice Address - Phone:859-940-6613
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-16
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities