MEDICARE: PREMIUM HOME HEALTH SERVICE INC

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

General Provider Information

NPI Number	:	1598840795
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIUM HOME HEALTH SERVICE INC

Provider Business Mailing Address
First Line	:	20504 WILLIAMSBURG RD
Second Line	:
City	:	DEARBORN HTS
State	:	MI
Zip	:	48127-2714
Country	:	US
Telephone Number	:	313-213-4460
Fax Number	:	313-724-9803

Provider Business Practice Location Address
First Line	:	20504 WILLIAMSBURG RD
Second Line	:
City	:	DEARBORN HTS
State	:	MI
Zip	:	48127-2714
Country	:	US
Telephone Number	:	313-213-4460
Fax Number	:	313-724-9803

Authorized Official
Title or Position	:	OWNER
Name	:	MR. SAMIR DAGHER IX
Credential	:
Telephone Number	:	313-213-4460

Provider Enumeration Date	:	10/26/2006
Last Update Date	:	08/22/2020

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