Provider Demographics
NPI:1891863536
Name:PREMIER HOSPICE LLC
Entity Type:Organization
Organization Name:PREMIER HOSPICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-890-8900
Mailing Address - Street 1:2800 CORPORATE EXCHANGE DRIVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43231
Mailing Address - Country:US
Mailing Address - Phone:614-890-8900
Mailing Address - Fax:614-890-8940
Practice Address - Street 1:3737 N 7TH ST
Practice Address - Street 2:SUITE 203
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-5017
Practice Address - Country:US
Practice Address - Phone:602-275-7572
Practice Address - Fax:602-274-5465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0162HSP251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH361635Medicare Oscar/Certification
OHAG-331Medicare ID - Type Unspecified