Provider Demographics
NPI:1801339486
Name:PREMIER ONE HOME CARE LLC
Entity type:Organization
Organization Name:PREMIER ONE HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHIAMAKA
Authorized Official - Middle Name:
Authorized Official - Last Name:KALU
Authorized Official - Suffix:
Authorized Official - Credentials:CNP
Authorized Official - Phone:614-554-9247
Mailing Address - Street 1:857 CEDAR RUN DR
Mailing Address - Street 2:
Mailing Address - City:BLACKLICK
Mailing Address - State:OH
Mailing Address - Zip Code:43004-8808
Mailing Address - Country:US
Mailing Address - Phone:614-554-3247
Mailing Address - Fax:
Practice Address - Street 1:857 CEDAR RUN DR
Practice Address - Street 2:
Practice Address - City:BLACKLICK
Practice Address - State:OH
Practice Address - Zip Code:43004-8808
Practice Address - Country:US
Practice Address - Phone:614-554-3247
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-30
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH251E00000X, 261QH0100X
253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service