Provider Demographics
NPI:1356363493
Name:PREMIER FAMILY HEALTH CARE SERVICES, LLC
Entity type:Organization
Organization Name:PREMIER FAMILY HEALTH CARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:STACIE
Authorized Official - Middle Name:MEDLIN
Authorized Official - Last Name:SHEARIN
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:252-519-2273
Mailing Address - Street 1:1704 HWY 158
Mailing Address - Street 2:
Mailing Address - City:ROANOKE RAPIDS
Mailing Address - State:NC
Mailing Address - Zip Code:27870-8378
Mailing Address - Country:US
Mailing Address - Phone:252-519-2273
Mailing Address - Fax:252-535-2399
Practice Address - Street 1:1704 HWY 158
Practice Address - Street 2:
Practice Address - City:ROANOKE RAPIDS
Practice Address - State:NC
Practice Address - Zip Code:27870-8378
Practice Address - Country:US
Practice Address - Phone:252-519-2273
Practice Address - Fax:252-535-2399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2009-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X
NCMHL-042-052251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8300375Medicaid
NC019YWOtherBCBS
NC3409692Medicaid
NC8388OtherLME PROVIDER NUMBER