Healthcare Provider Details

I. General information

NPI: 1770404451
Provider Name (Legal Business Name): PREMIUM HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11766 GLOVER ST
AXIS AL
36505-4358
US

IV. Provider business mailing address

3303 KENDLESHIRE LN
FULSHEAR TX
77441-2734
US

V. Phone/Fax

Practice location:
  • Phone: 832-566-2599
  • Fax:
Mailing address:
  • Phone: 832-566-2599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: ROBIN DEMINGS
Title or Position: CFO
Credential: OWNER
Phone: 832-566-2599