Healthcare Provider Details

I. General information

NPI: 1902739667
Provider Name (Legal Business Name): PREMIUM INDEPENDENCE AND CARE SOLUTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 WINDWARD PL
OLDSMAR FL
34677-2243
US

IV. Provider business mailing address

1703 N MCMULLEN BOOTH RD UNIT 434
SAFETY HARBOR FL
34695-9618
US

V. Phone/Fax

Practice location:
  • Phone: 727-296-6953
  • Fax:
Mailing address:
  • Phone: 727-296-6953
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. VALERIE SOTO
Title or Position: ADMINISTRATOR
Credential:
Phone: 727-296-6953