Provider Demographics
NPI:1700430824
Name:PREMIERCHOICE, LLC
Entity Type:Organization
Organization Name:PREMIERCHOICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NIYAH
Authorized Official - Middle Name:
Authorized Official - Last Name:NEWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-735-4411
Mailing Address - Street 1:602 N MISSOURI ST
Mailing Address - Street 2:
Mailing Address - City:WEST MEMPHIS
Mailing Address - State:AR
Mailing Address - Zip Code:72301-3148
Mailing Address - Country:US
Mailing Address - Phone:870-735-4411
Mailing Address - Fax:870-733-0301
Practice Address - Street 1:602 N MISSOURI ST
Practice Address - Street 2:
Practice Address - City:WEST MEMPHIS
Practice Address - State:AR
Practice Address - Zip Code:72301-3148
Practice Address - Country:US
Practice Address - Phone:870-735-4411
Practice Address - Fax:870-733-0301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-26
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR203614732Medicaid