Provider Demographics
NPI:1881742419
Name:PREMIERE HOME HEALTH, INC.
Entity type:Organization
Organization Name:PREMIERE HOME HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTADMINISTRATOR/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOSEFINA
Authorized Official - Middle Name:C
Authorized Official - Last Name:FLORES
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:626-281-4088
Mailing Address - Street 1:2225 W COMMONWEALTH AVE
Mailing Address - Street 2:STE.306
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91803-1332
Mailing Address - Country:US
Mailing Address - Phone:626-281-4088
Mailing Address - Fax:626-281-4058
Practice Address - Street 1:2225 W COMMONWEALTH AVE
Practice Address - Street 2:STE.306
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91803-1332
Practice Address - Country:US
Practice Address - Phone:626-281-4088
Practice Address - Fax:626-281-4058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2014-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA980001592251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA058373OtherCMS CERTIFICATION NUMBER