Healthcare Provider Details

I. General information

NPI: 1154185395
Provider Name (Legal Business Name): PREMIUM STANDARD HOME CARE OF OHIO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2024
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1764 ALEC PLACE
ATLANTA GA
30329
US

IV. Provider business mailing address

815 SUPERIOR AVE E STE 1618
CLEVELAND OH
44114-2709
US

V. Phone/Fax

Practice location:
  • Phone: 404-545-6888
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MS. GIANINA WALKER
Title or Position: OWNER
Credential:
Phone: 404-545-6888