Healthcare Provider Details

I. General information

NPI: 1720596562
Provider Name (Legal Business Name): PREMIER HOME HEALTH MANAGEMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2018
Last Update Date: 09/23/2022
Certification Date: 09/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2603 DECATUR HWY
GARDENDALE AL
35071-2185
US

IV. Provider business mailing address

PO BOX 1344
GARDENDALE AL
35071-1344
US

V. Phone/Fax

Practice location:
  • Phone: 205-306-4674
  • Fax: 205-449-2880
Mailing address:
  • Phone: 205-306-4674
  • Fax: 205-449-2880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: CHERYL D PREWITT
Title or Position: CEO/CARE MANAGER
Credential:
Phone: 205-306-4674