Provider Demographics
NPI:1891206041
Name:PREMIER MEDICAL HOUSECALLS LLC
Entity Type:Organization
Organization Name:PREMIER MEDICAL HOUSECALLS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:JACQUES
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:772-361-3854
Mailing Address - Street 1:1825 NW CORPORATE BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-8554
Mailing Address - Country:US
Mailing Address - Phone:772-361-3854
Mailing Address - Fax:
Practice Address - Street 1:1825 NW CORPORATE BLVD STE 110
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-8554
Practice Address - Country:US
Practice Address - Phone:772-361-3854
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-16
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9345557363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty