Provider Demographics
NPI:1356111090
Name:PREMIER PSYCHIATRIC SERVICES LLC
Entity type:Organization
Organization Name:PREMIER PSYCHIATRIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:JARRYD
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:MCGUIRE
Authorized Official - Suffix:
Authorized Official - Credentials:APN
Authorized Official - Phone:815-408-0988
Mailing Address - Street 1:125 W MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:NEW LENOX
Mailing Address - State:IL
Mailing Address - Zip Code:60451-1739
Mailing Address - Country:US
Mailing Address - Phone:815-408-0988
Mailing Address - Fax:815-408-1081
Practice Address - Street 1:125 W MAPLE ST
Practice Address - Street 2:
Practice Address - City:NEW LENOX
Practice Address - State:IL
Practice Address - Zip Code:60451-1739
Practice Address - Country:US
Practice Address - Phone:815-408-0988
Practice Address - Fax:815-697-4326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-04
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health