MEDICARE: PREMIER CARE OF OHIO, LLC.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251S00000X	Community/Behavioral Health Agency
2	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
3	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center
4	101YA0400X	Addiction (Substance Use Disorder) Counselor
5	261QM2800X	Methadone Clinic

General Provider Information

NPI Number	:	1396343844
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIER CARE OF OHIO, LLC.

Provider Business Mailing Address
First Line	:	8444 N 90TH ST STE 100
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85258-4437
Country	:	US
Telephone Number	:	602-248-8886
Fax Number	:	480-687-7361

Provider Business Practice Location Address
First Line	:	5 SEVERANCE CIR STE 101
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44118-1513
Country	:	US
Telephone Number	:	216-859-8300
Fax Number	:	920-926-0060

Authorized Official
Title or Position	:	VP REVENUE CYCLE MGMT
Name	:	CINDY GAITHER
Credential	:
Telephone Number	:	602-248-8886

Provider Enumeration Date	:	10/15/2020
Last Update Date	:	02/09/2024

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