Provider Demographics
NPI:1154166098
Name:PREMIUM CARE ASSOCIATES
Entity type:Organization
Organization Name:PREMIUM CARE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:EUNICE
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS RAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-439-4452
Mailing Address - Street 1:2538 ROSEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:CLIO
Mailing Address - State:SC
Mailing Address - Zip Code:29525-4436
Mailing Address - Country:US
Mailing Address - Phone:843-439-4452
Mailing Address - Fax:
Practice Address - Street 1:209 BALL PARK ST
Practice Address - Street 2:SUITE E
Practice Address - City:BENNETTSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29512
Practice Address - Country:US
Practice Address - Phone:843-439-4452
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-01
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care