Provider Demographics
NPI:1912538679
Name:PREMIER PERSONAL CARE AGENCY LLC
Entity Type:Organization
Organization Name:PREMIER PERSONAL CARE AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RACHEAL
Authorized Official - Middle Name:
Authorized Official - Last Name:KALAMA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:414-628-2774
Mailing Address - Street 1:10520 W BLUEMOUND RD STE 105
Mailing Address - Street 2:SUITE #105
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-4484
Mailing Address - Country:US
Mailing Address - Phone:414-231-3277
Mailing Address - Fax:414-231-3172
Practice Address - Street 1:10520 W BLUEMOUND RD STE 105
Practice Address - Street 2:SUITE #105
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-4484
Practice Address - Country:US
Practice Address - Phone:414-231-3277
Practice Address - Fax:414-231-3172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-31
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100095822Medicaid