Provider Demographics
NPI:1720011208
Name:PREMIUM HOME HEALTH CARE INC
Entity Type:Organization
Organization Name:PREMIUM HOME HEALTH CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:HEBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:PENA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-222-2260
Mailing Address - Street 1:2760 SW 97TH AVE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-2684
Mailing Address - Country:US
Mailing Address - Phone:305-222-2260
Mailing Address - Fax:305-222-2212
Practice Address - Street 1:2760 SW 97TH AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-2684
Practice Address - Country:US
Practice Address - Phone:305-222-2260
Practice Address - Fax:305-222-2212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299991661251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL108021Medicare Oscar/Certification