Healthcare Provider Details

I. General information

NPI: 1629791934
Provider Name (Legal Business Name): PREMIER SERVICES AT HOME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2022
Last Update Date: 05/01/2025
Certification Date: 05/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 BRICK KILN RD UNIT 214
CHELMSFORD MA
01824-3259
US

IV. Provider business mailing address

121 BRICK KILN RD UNIT 214
CHELMSFORD MA
01824-3259
US

V. Phone/Fax

Practice location:
  • Phone: 978-710-1701
  • Fax:
Mailing address:
  • Phone: 978-710-1701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. VICTOR MWAURAH
Title or Position: CEO
Credential:
Phone: 978-654-1701