Healthcare Provider Details

I. General information

NPI: 1588009021
Provider Name (Legal Business Name): PREMIER HOME HEALTH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2013
Last Update Date: 05/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4530 E SHEA BLVD SUITE 165
PHOENIX AZ
85028-6065
US

IV. Provider business mailing address

1910 FAIRVIEW AVE E SUITE 500
SEATTLE WA
98102-3620
US

V. Phone/Fax

Practice location:
  • Phone: 602-274-7572
  • Fax:
Mailing address:
  • Phone: 206-576-0087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVID H KOSLOFF
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 206-576-0087