MEDICARE: PREMIUM CARE HEALTH 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	3747A0650X	Attendant Care Provider
2	253Z00000X	In Home Supportive Care Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	299995289	OTHER	FL	AHCA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760051171
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIUM CARE HEALTH SERVICES, LLC

Provider Business Mailing Address
First Line	:	10300 SW 72ND ST STE 200
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33173-3040
Country	:	US
Telephone Number	:	305-336-6275
Fax Number	:	786-254-5162

Provider Business Practice Location Address
First Line	:	10300 SW 72ND ST STE 200
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33173-3040
Country	:	US
Telephone Number	:	305-336-6275
Fax Number	:	786-254-5162

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	LUISA RONDON-LASSEN
Credential	:
Telephone Number	:	305-336-6275

Provider Enumeration Date	:	06/21/2021
Last Update Date	:	05/13/2022

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Directions to “PREMIUM CARE HEALTH SERVICES, LLC ” Practice Location

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