Provider Demographics
NPI:1306919576
Name:APREMIUM HEALTHCARE SOLUTION, LLC
Entity type:Organization
Organization Name:APREMIUM HEALTHCARE SOLUTION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:A
Authorized Official - Last Name:NELOMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-789-9253
Mailing Address - Street 1:1804 OVERLAKE DRIVE
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-2187
Mailing Address - Country:US
Mailing Address - Phone:678-895-2050
Mailing Address - Fax:678-669-2031
Practice Address - Street 1:1804 OVERLAKE DRIVE
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-2187
Practice Address - Country:US
Practice Address - Phone:678-895-2050
Practice Address - Fax:678-669-2031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA011-R-0320251E00000X
GA122-R-0004251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA362614674DMedicaid
GA362614674CMedicaid
GA362614674BMedicaid
GA362614674AMedicaid