MEDICARE: PREMIER HOME COMPANION 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	385HR2060X	Child Intellectual and/or Developmental Disabilities Respite Care	234334	FL
2	253Z00000X	In Home Supportive Care Agency	234334	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	234334	OTHER	FL	AGENCY FOR HEALTH CARE ADMINSTRATION

General Provider Information

NPI Number	:	1700247137
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIER HOME COMPANION SERVICES, LLC

Provider Business Mailing Address
First Line	:	PO BOX 20681
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32316-0681
Country	:	US
Telephone Number	:	850-508-3397
Fax Number	:

Provider Business Practice Location Address
First Line	:	475 APPLEYARD DR
Second Line	:	APT 112
City	:	TALLAHASSEE
State	:	FL
Zip	:	32304-2808
Country	:	US
Telephone Number	:	850-508-3397
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. CURTIS EUGENE BRIDGES II
Credential	:
Telephone Number	:	850-508-3397

Provider Enumeration Date	:	03/13/2016
Last Update Date	:	03/13/2016

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