Provider Demographics
NPI:1366739203
Name:PREMIER HANDICAP SERVICES
Entity type:Organization
Organization Name:PREMIER HANDICAP SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:MULUH
Authorized Official - Last Name:AWA / MULUH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-467-9684
Mailing Address - Street 1:1342 PROSPERITY AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55106-2109
Mailing Address - Country:US
Mailing Address - Phone:612-467-9684
Mailing Address - Fax:
Practice Address - Street 1:1342 PROSPERITY AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55106-2109
Practice Address - Country:US
Practice Address - Phone:612-467-9684
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-29
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN742GHA343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)