Provider Demographics
NPI:1396570834
Name:PREMIUM CARE INC
Entity type:Organization
Organization Name:PREMIUM CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:OLUGBENGA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAOYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-437-2218
Mailing Address - Street 1:7413 MATAPAN DR
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:MD
Mailing Address - Zip Code:21076-2104
Mailing Address - Country:US
Mailing Address - Phone:240-437-2218
Mailing Address - Fax:
Practice Address - Street 1:7413 MATAPAN DR
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:MD
Practice Address - Zip Code:21076-2104
Practice Address - Country:US
Practice Address - Phone:240-437-2218
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-04
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities