Provider Demographics
NPI:1942852751
Name:PREMIUM HOMECARE AGENCY LLC
Entity Type:Organization
Organization Name:PREMIUM HOMECARE AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CLARINCE
Authorized Official - Middle Name:
Authorized Official - Last Name:JEAN BAPTISTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-305-5263
Mailing Address - Street 1:89 GREEN LODGE ST
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MA
Mailing Address - Zip Code:02021-1131
Mailing Address - Country:US
Mailing Address - Phone:781-298-7112
Mailing Address - Fax:
Practice Address - Street 1:89 GREEN LODGE ST
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MA
Practice Address - Zip Code:02021-1131
Practice Address - Country:US
Practice Address - Phone:781-298-7112
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-11
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health