Provider Demographics
NPI:1780603134
Name:PREMIER HOME HEALTH CARE, INC.
Entity type:Organization
Organization Name:PREMIER HOME HEALTH CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:918-427-1900
Mailing Address - Street 1:1016 E. SHAWNTEL SMITH BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:MULDROW
Mailing Address - State:OK
Mailing Address - Zip Code:74948
Mailing Address - Country:US
Mailing Address - Phone:918-427-1900
Mailing Address - Fax:918-427-9967
Practice Address - Street 1:1016 E. SHAWNTEL SMITH BOULEVARD
Practice Address - Street 2:SUITE 2
Practice Address - City:MULDROW
Practice Address - State:OK
Practice Address - Zip Code:74948
Practice Address - Country:US
Practice Address - Phone:918-427-1900
Practice Address - Fax:877-700-6210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK377706Medicare Oscar/Certification