Provider Demographics
NPI:1841053998
Name:PREMIUM HOST CARE
Entity type:Organization
Organization Name:PREMIUM HOST CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SILIA
Authorized Official - Middle Name:TUPOU
Authorized Official - Last Name:VAITAI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:385-371-8469
Mailing Address - Street 1:154 W 600 S UNIT 250
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84101-2784
Mailing Address - Country:US
Mailing Address - Phone:385-371-8469
Mailing Address - Fax:
Practice Address - Street 1:154 W 600 S UNIT 250
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84101-2784
Practice Address - Country:US
Practice Address - Phone:385-371-8469
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-01
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty