Provider Demographics
NPI:1699456251
Name:PREMIER UPSTATE PROPERTIES
Entity type:Organization
Organization Name:PREMIER UPSTATE PROPERTIES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:BOOTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-846-2370
Mailing Address - Street 1:168 MILLER ST APT B103
Mailing Address - Street 2:
Mailing Address - City:HORSEHEADS
Mailing Address - State:NY
Mailing Address - Zip Code:14845-1861
Mailing Address - Country:US
Mailing Address - Phone:607-846-2370
Mailing Address - Fax:607-398-2448
Practice Address - Street 1:168 MILLER ST APT B103
Practice Address - Street 2:
Practice Address - City:HORSEHEADS
Practice Address - State:NY
Practice Address - Zip Code:14845-1861
Practice Address - Country:US
Practice Address - Phone:607-846-2370
Practice Address - Fax:607-398-2448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-27
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
No174200000XOther Service ProvidersMeals
No251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty