Healthcare Provider Details

I. General information

NPI: 1649539917
Provider Name (Legal Business Name): PREMIER HOME HEALTH CARE & HOSPICE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2012
Last Update Date: 05/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5441 FAIR OAKS BLVD SUITE B2/B3
CARMICHAEL CA
95608-5798
US

IV. Provider business mailing address

5441 FAIR OAKS BLVD SUITE B2/B3
CARMICHAEL CA
95608-5798
US

V. Phone/Fax

Practice location:
  • Phone: 916-486-4262
  • Fax: 916-486-4342
Mailing address:
  • Phone: 916-486-4262
  • Fax: 916-486-4342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. JACOB EAPEN
Title or Position: PRESIDENT/OWNER
Credential: M.D.
Phone: 916-486-4262