Provider Demographics
NPI:1700337029
Name:PREMIERE HEALTHCARE ASSOCIATES LLC
Entity Type:Organization
Organization Name:PREMIERE HEALTHCARE ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:JO
Authorized Official - Last Name:GUTIERREZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, RN, ANP-BC,ACNS
Authorized Official - Phone:303-918-6386
Mailing Address - Street 1:15400 W 64TH AVE
Mailing Address - Street 2:UNIT 9 BOX 359
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80007-6852
Mailing Address - Country:US
Mailing Address - Phone:303-918-6386
Mailing Address - Fax:303-232-6201
Practice Address - Street 1:14828 W 6TH AVE
Practice Address - Street 2:SUITE 16-B
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401-5000
Practice Address - Country:US
Practice Address - Phone:303-918-6386
Practice Address - Fax:303-232-6201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-21
Last Update Date:2016-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1866261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO62534084Medicaid
COC805862Medicare PIN