Provider Demographics
NPI:1245061340
Name:PREMIUM PSYCHIATRIC CARE NURSING -PC
Entity type:Organization
Organization Name:PREMIUM PSYCHIATRIC CARE NURSING -PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ABIBAT
Authorized Official - Middle Name:
Authorized Official - Last Name:AJIBOYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-261-7728
Mailing Address - Street 1:4695 CHABOT DR STE 200
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-2756
Mailing Address - Country:US
Mailing Address - Phone:925-261-7728
Mailing Address - Fax:925-420-8625
Practice Address - Street 1:4695 CHABOT DR STE 200
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-2756
Practice Address - Country:US
Practice Address - Phone:925-261-7728
Practice Address - Fax:925-420-8625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-10
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty