Provider Demographics
NPI:1700247137
Name:PREMIER HOME COMPANION SERVICES, LLC
Entity Type:Organization
Organization Name:PREMIER HOME COMPANION SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CURTIS
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:BRIDGES
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:850-508-3397
Mailing Address - Street 1:PO BOX 20681
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32316-0681
Mailing Address - Country:US
Mailing Address - Phone:850-508-3397
Mailing Address - Fax:
Practice Address - Street 1:475 APPLEYARD DR
Practice Address - Street 2:APT 112
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32304-2808
Practice Address - Country:US
Practice Address - Phone:850-508-3397
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-13
Last Update Date:2016-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL234334253Z00000X, 385HR2060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL234334OtherAGENCY FOR HEALTH CARE ADMINSTRATION