Healthcare Provider Details

I. General information

NPI: 1437289840
Provider Name (Legal Business Name): PREMIUM SELECT HOME CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 03/05/2020
Certification Date: 03/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5513 ILLINOIS AVE NW
WASHINGTON DC
20011-2937
US

IV. Provider business mailing address

5513 ILLINOIS AVE NW
WASHINGTON DC
20011-2937
US

V. Phone/Fax

Practice location:
  • Phone: 202-882-9310
  • Fax: 202-882-9374
Mailing address:
  • Phone: 202-882-9310
  • Fax: 202-882-9374

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number097050
License Number StateDC

VIII. Authorized Official

Name: MRS. LINDA HART DAVIS
Title or Position: ADMINISTRATOR
Credential: R.N., M.S.
Phone: 202-882-9310