Provider Demographics
NPI:1255313748
Name:PREMIER HOME CARE, INC.
Entity type:Organization
Organization Name:PREMIER HOME CARE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CCO
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSSALESI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-246-9499
Mailing Address - Street 1:555 E NORTH LN STE 5075
Mailing Address - Street 2:
Mailing Address - City:CONSHOHOCKEN
Mailing Address - State:PA
Mailing Address - Zip Code:19428-2490
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2195 WATTERSON TRL
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40299-2437
Practice Address - Country:US
Practice Address - Phone:502-491-5243
Practice Address - Fax:888-678-7190
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AEROCARE HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-11-18
Last Update Date:2025-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY199493332B00000X
335E00000X
KY909286332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100035240Medicaid
KYMG0332OtherKENTUCKY BOARD OF PHARMACY LICENSE
IN389449POtherSIHO
KS1074015Medicaid
IN200147650Medicaid
KY91022OtherAPB
KY400030OtherBLACK LUNG
KY45909991OtherEPSDT
KY80341OtherNORTHWOOD
KY000000069783OtherANTHEM ID
KS1074015Medicaid