Provider Demographics
NPI:1063227528
Name:PREMIER HOME CARE 1 LLC
Entity type:Organization
Organization Name:PREMIER HOME CARE 1 LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAKOTA
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:PRUITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-851-4334
Mailing Address - Street 1:6736 N 129TH EAST AVE
Mailing Address - Street 2:
Mailing Address - City:OWASSO
Mailing Address - State:OK
Mailing Address - Zip Code:74055-7160
Mailing Address - Country:US
Mailing Address - Phone:918-851-4334
Mailing Address - Fax:
Practice Address - Street 1:901 SE 28TH ST
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-3880
Practice Address - Country:US
Practice Address - Phone:479-448-5919
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-11
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care