Provider Demographics
NPI:1265814230
Name:TRI-STATE PREMIER HEALTHCARE SERVICE
Entity type:Organization
Organization Name:TRI-STATE PREMIER HEALTHCARE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF NURSING
Authorized Official - Prefix:
Authorized Official - First Name:CLARISSE
Authorized Official - Middle Name:
Authorized Official - Last Name:NYAM
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:513-310-7597
Mailing Address - Street 1:1250 MISTY LAKE LN
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:OH
Mailing Address - Zip Code:45103-1184
Mailing Address - Country:US
Mailing Address - Phone:513-227-9266
Mailing Address - Fax:
Practice Address - Street 1:1250 MISTY LAKE LN
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:OH
Practice Address - Zip Code:45103-1184
Practice Address - Country:US
Practice Address - Phone:513-227-9266
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-25
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251F00000XAgenciesHome Infusion
No253Z00000XAgenciesIn Home Supportive Care
No251J00000XAgenciesNursing Care
No251E00000XAgenciesHome Health