Provider Demographics
NPI:1104797182
Name:PREMIUM CARE MIHP LLC
Entity type:Organization
Organization Name:PREMIUM CARE MIHP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORGANIZER
Authorized Official - Prefix:
Authorized Official - First Name:D'ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:GILBREATH
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:248-893-9530
Mailing Address - Street 1:PO BOX 3251
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48037-3251
Mailing Address - Country:US
Mailing Address - Phone:248-893-9530
Mailing Address - Fax:
Practice Address - Street 1:29226 ORCHARD LAKE RD STE 140
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-2990
Practice Address - Country:US
Practice Address - Phone:248-893-9530
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-15
Last Update Date:2025-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare