Healthcare Provider Details

I. General information

NPI: 1487443131
Provider Name (Legal Business Name): PREMIUM STANDARD HOME HEALTH INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2025
Last Update Date: 06/11/2025
Certification Date: 06/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9333 BENTON DR
FISHERS IN
46038-8407
US

IV. Provider business mailing address

9333 BENTON DR
FISHERS IN
46038-8407
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

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