Provider Demographics
NPI:1912737891
Name:PREMIUM CARE TEXAS LLC
Entity type:Organization
Organization Name:PREMIUM CARE TEXAS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TITILOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:ADIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-933-4450
Mailing Address - Street 1:4703 LUNSFORD HOLLOW LN
Mailing Address - Street 2:
Mailing Address - City:FRIENDSWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77546-2514
Mailing Address - Country:US
Mailing Address - Phone:832-933-4450
Mailing Address - Fax:
Practice Address - Street 1:1560 W BAY AREA BLVD STE 170
Practice Address - Street 2:
Practice Address - City:FRIENDSWOOD
Practice Address - State:TX
Practice Address - Zip Code:77546-2683
Practice Address - Country:US
Practice Address - Phone:832-933-4450
Practice Address - Fax:281-954-6097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-05
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty