Healthcare Provider Details

I. General information

NPI: 1942992714
Provider Name (Legal Business Name): 1 A A PREMIER HOME CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2023
Last Update Date: 10/23/2025
Certification Date: 10/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1008 W SANETTA ST
NAMPA ID
83651-5047
US

IV. Provider business mailing address

1008 W SANETTA ST
NAMPA ID
83651-5047
US

V. Phone/Fax

Practice location:
  • Phone: 208-631-3940
  • Fax:
Mailing address:
  • Phone: 208-631-3940
  • Fax:

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 Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MR. CHARLES JOHN MICHELSEN IV
Title or Position: COO
Credential:
Phone: 208-631-3940