Provider Demographics
NPI:1255695557
Name:PREMIER WELLNESS CARE INC.
Entity type:Organization
Organization Name:PREMIER WELLNESS CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:GUINSATAO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-898-5064
Mailing Address - Street 1:115 S LA SALLE ST
Mailing Address - Street 2:STE 2600
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60603-3801
Mailing Address - Country:US
Mailing Address - Phone:312-898-5064
Mailing Address - Fax:847-886-4158
Practice Address - Street 1:400 HIGGINS RD
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-5751
Practice Address - Country:US
Practice Address - Phone:847-425-9089
Practice Address - Fax:847-886-4158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-02
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty