Healthcare Provider Details

I. General information

NPI: 1033092697
Provider Name (Legal Business Name): PREMIUM HEALTHCARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2025
Last Update Date: 07/30/2025
Certification Date: 07/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6702 CHAPEL DALE RD
BOWIE MD
20720-5217
US

IV. Provider business mailing address

6702 CHAPEL DALE RD
BOWIE MD
20720-5217
US

V. Phone/Fax

Practice location:
  • Phone: 617-412-8515
  • Fax:
Mailing address:
  • Phone: 617-412-8515
  • 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 Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: NOSIMOT ADENIKE BUHARI
Title or Position: CEO
Credential:
Phone: 617-412-8515