Healthcare Provider Details

I. General information

NPI: 1225959794
Provider Name (Legal Business Name): PREMIER CARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 44TH AVE
NORTHLAKE IL
60164-2637
US

IV. Provider business mailing address

209 44TH AVE
NORTHLAKE IL
60164-2637
US

V. Phone/Fax

Practice location:
  • Phone: 201-771-0043
  • Fax:
Mailing address:
  • Phone: 201-771-0043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DERRICK CABRERA
Title or Position: BILLING MANAGER
Credential:
Phone: 201-771-0043