Healthcare Provider Details

I. General information

NPI: 1760051171
Provider Name (Legal Business Name): PREMIUM CARE HEALTH SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2021
Last Update Date: 05/13/2022
Certification Date: 05/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10300 SW 72ND ST STE 200
MIAMI FL
33173-3040
US

IV. Provider business mailing address

10300 SW 72ND ST STE 200
MIAMI FL
33173-3040
US

V. Phone/Fax

Practice location:
  • Phone: 305-336-6275
  • Fax: 786-254-5162
Mailing address:
  • Phone: 305-336-6275
  • Fax: 786-254-5162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State

VIII. Authorized Official

Name: LUISA RONDON-LASSEN
Title or Position: ADMINISTRATOR
Credential:
Phone: 305-336-6275