Provider Demographics
NPI:1275834491
Name:PREMIER HOME CARE
Entity Type:Organization
Organization Name:PREMIER HOME CARE
Other - Org Name:PREMIER OUTPATIENT THERAPIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAWANNA
Authorized Official - Middle Name:LOU
Authorized Official - Last Name:BEST
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:719-395-3124
Mailing Address - Street 1:301 HWY 24 N, BOX 5007
Mailing Address - Street 2:
Mailing Address - City:BUENA VISTA
Mailing Address - State:CO
Mailing Address - Zip Code:81211-5007
Mailing Address - Country:US
Mailing Address - Phone:719-395-3124
Mailing Address - Fax:719-395-3128
Practice Address - Street 1:301 HWY 24 N
Practice Address - Street 2:
Practice Address - City:BUENA VISTA
Practice Address - State:CO
Practice Address - Zip Code:81211-5007
Practice Address - Country:US
Practice Address - Phone:719-395-3124
Practice Address - Fax:719-395-3128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-04
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO067455251E00000X
CO1518275767261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO067455OtherMEDICARE
CO54229863Medicaid