MEDICARE: PREMIUM HOME HEALTH 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	251F00000X	Home Infusion Agency

General Provider Information

NPI Number	:	1801569405
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIUM HOME HEALTH LLC

Provider Business Mailing Address
First Line	:	130 N 2ND ST UNIT 1A
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19106-4604
Country	:	US
Telephone Number	:	215-709-0254
Fax Number	:

Provider Business Practice Location Address
First Line	:	130 N 2ND ST UNIT 1A
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19106-4604
Country	:	US
Telephone Number	:	215-709-0254
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	FAHAD HASHMI
Credential	:
Telephone Number	:	215-709-0254

Provider Enumeration Date	:	07/29/2021
Last Update Date	:	07/29/2021

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