Provider Demographics
NPI:1316757743
Name:PREMIER WAIVER HOMES LLC
Entity type:Organization
Organization Name:PREMIER WAIVER HOMES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:SETH
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:HUDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-870-4793
Mailing Address - Street 1:PO BOX 364
Mailing Address - Street 2:
Mailing Address - City:CLARINDA
Mailing Address - State:IA
Mailing Address - Zip Code:51632-0364
Mailing Address - Country:US
Mailing Address - Phone:712-242-5993
Mailing Address - Fax:
Practice Address - Street 1:701 WEST ST
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:IA
Practice Address - Zip Code:51601-1936
Practice Address - Country:US
Practice Address - Phone:712-242-5993
Practice Address - Fax:515-655-8519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-08
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities