MEDICARE: PREMIER HEALTHCARE SERVICES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	550001478	CA

General Provider Information

NPI Number	:	1093946238
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIER HEALTHCARE SERVICES, LLC

Provider Business Mailing Address
First Line	:	400 INTERSTATE NORTH PKWY SE STE 1600
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30339-5047
Country	:	US
Telephone Number	:	470-464-8000
Fax Number	:	770-248-8192

Provider Business Practice Location Address
First Line	:	25129 THE OLD RD STE 320
Second Line	:
City	:	STEVENSON RANCH
State	:	CA
Zip	:	91381-2393
Country	:	US
Telephone Number	:	661-253-1100
Fax Number	:	888-598-0409

Authorized Official
Title or Position	:	CFO
Name	:	MATTHEW BUCKHALTER
Credential	:
Telephone Number	:	470-464-8000

Provider Enumeration Date	:	08/05/2009
Last Update Date	:	01/28/2025

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