Provider Demographics
NPI:1720066129
Name:PREMIER HEALTHCARE SERVICES INC
Entity Type:Organization
Organization Name:PREMIER HEALTHCARE SERVICES INC
Other - Org Name:MT PLEASANT NURSING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:J
Authorized Official - Last Name:STAMM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-251-3070
Mailing Address - Street 1:1355 CLAYTON RD
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95127-4307
Mailing Address - Country:US
Mailing Address - Phone:408-251-3070
Mailing Address - Fax:408-251-6567
Practice Address - Street 1:1355 CLAYTON RD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95127-4307
Practice Address - Country:US
Practice Address - Phone:408-251-3070
Practice Address - Fax:408-251-6567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-05
Last Update Date:2013-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA070000068314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZR18445HMedicaid
CAZZR18445HMedicaid