Healthcare Provider Details

I. General information

NPI: 1871841114
Provider Name (Legal Business Name): PREMIER THERAPY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2012
Last Update Date: 12/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 EASTERN BYP SUITE 145
RICHMOND KY
40475-2562
US

IV. Provider business mailing address

330 EASTERN BYP SUITE 145
RICHMOND KY
40475-2562
US

V. Phone/Fax

Practice location:
  • Phone: 859-940-6613
  • Fax:
Mailing address:
  • Phone: 859-940-6613
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License Number
License Number StateKY

VIII. Authorized Official

Name: DAVID CLARK
Title or Position: MANAGING MEMBER
Credential:
Phone: 859-940-6613