Provider Demographics
NPI:1841025350
Name:PREMIUM HOME HEALTH
Entity type:Organization
Organization Name:PREMIUM HOME HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ALTERNATE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:NWOKEDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-469-3360
Mailing Address - Street 1:881 DECLARATION DRIVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBORO
Mailing Address - State:IN
Mailing Address - Zip Code:46167
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:881 DECLARATION DRIVE
Practice Address - Street 2:
Practice Address - City:PITTSBORO
Practice Address - State:IN
Practice Address - Zip Code:46167
Practice Address - Country:US
Practice Address - Phone:317-744-3022
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-04
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health