Provider Demographics
NPI:1265890792
Name:PREMIER CARE GROUP
Entity type:Organization
Organization Name:PREMIER CARE GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHELIE-ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:DYGES
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:954-394-0354
Mailing Address - Street 1:7233 NW 49TH CT
Mailing Address - Street 2:
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33319-3446
Mailing Address - Country:US
Mailing Address - Phone:954-394-0354
Mailing Address - Fax:
Practice Address - Street 1:7233 NW 49TH CT
Practice Address - Street 2:
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33319-3446
Practice Address - Country:US
Practice Address - Phone:954-394-0354
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-28
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management