Healthcare Provider Details

I. General information

NPI: 1720066129
Provider Name (Legal Business Name): PREMIER HEALTHCARE SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2006
Last Update Date: 10/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1355 CLAYTON RD
SAN JOSE CA
95127-4307
US

IV. Provider business mailing address

1355 CLAYTON RD
SAN JOSE CA
95127-4307
US

V. Phone/Fax

Practice location:
  • Phone: 408-251-3070
  • Fax: 408-251-6567
Mailing address:
  • Phone: 408-251-3070
  • Fax: 408-251-6567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number070000068
License Number StateCA

VIII. Authorized Official

Name: FREDERICK J STAMM
Title or Position: ADMINISTRATOR
Credential:
Phone: 408-251-3070