Provider Demographics
NPI:1275349664
Name:PREMIER PROFESSIONAL HOME CARE CORP
Entity type:Organization
Organization Name:PREMIER PROFESSIONAL HOME CARE CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MILDRED
Authorized Official - Middle Name:
Authorized Official - Last Name:NIEVES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-343-0841
Mailing Address - Street 1:10300 SW 72ND ST STE 190
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-3040
Mailing Address - Country:US
Mailing Address - Phone:305-343-0841
Mailing Address - Fax:786-636-8946
Practice Address - Street 1:10300 SW 72ND ST STE 190
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3040
Practice Address - Country:US
Practice Address - Phone:305-343-0841
Practice Address - Fax:786-636-8946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-10
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty