Healthcare Provider Details

I. General information

NPI: 1700247137
Provider Name (Legal Business Name): PREMIER HOME COMPANION SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2016
Last Update Date: 03/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 APPLEYARD DR APT 112
TALLAHASSEE FL
32304-2808
US

IV. Provider business mailing address

PO BOX 20681
TALLAHASSEE FL
32316-0681
US

V. Phone/Fax

Practice location:
  • Phone: 850-508-3397
  • Fax:
Mailing address:
  • Phone: 850-508-3397
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number234334
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number234334
License Number StateFL

VIII. Authorized Official

Name: MR. CURTIS EUGENE BRIDGES II
Title or Position: ADMINISTRATOR
Credential:
Phone: 850-508-3397