Provider Demographics
NPI:1649883158
Name:LEGACY PREMEIR HEALTHCARE SERVICES
Entity type:Organization
Organization Name:LEGACY PREMEIR HEALTHCARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ZARETTE
Authorized Official - Middle Name:MECHELLE
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:321-295-1314
Mailing Address - Street 1:581 N PARK AVE UNIT 2472
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32704-8707
Mailing Address - Country:US
Mailing Address - Phone:321-356-7792
Mailing Address - Fax:
Practice Address - Street 1:213 22ND ST NE
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-1631
Practice Address - Country:US
Practice Address - Phone:321-295-1314
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-25
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Multi-Specialty
No251J00000XAgenciesNursing CareGroup - Multi-Specialty
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child