Healthcare Provider Details

I. General information

NPI: 1518275767
Provider Name (Legal Business Name): PREMIER HOME CARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2010
Last Update Date: 01/08/2020
Certification Date: 01/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 HWY 24 N
BUENA VISTA CO
81211
US

IV. Provider business mailing address

PO BOX 5007 301 HWY 24 N
BUENA VISTA CO
81211-5007
US

V. Phone/Fax

Practice location:
  • Phone: 719-395-3124
  • Fax: 719-395-3128
Mailing address:
  • Phone: 719-395-3124
  • Fax: 719-395-3128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number160003053
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number8425
License Number StateCO

VIII. Authorized Official

Name: LAWANNA LOU BEST
Title or Position: CEO
Credential: RN
Phone: 719-395-3124