Healthcare Provider Details

I. General information

NPI: 1013211036
Provider Name (Legal Business Name): PREMIER SECURITY SYS OF WASHINGTON INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2011
Last Update Date: 01/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11321 MOXLEY RD
DAMASCUS MD
20872-1332
US

IV. Provider business mailing address

11321 MOXLEY RD
DAMASCUS MD
20872-1332
US

V. Phone/Fax

Practice location:
  • Phone: 301-840-3477
  • Fax:
Mailing address:
  • Phone: 301-840-3477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number11-6236
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number11-6236
License Number StateVA

VIII. Authorized Official

Name: MS. DIANE CHUCKER
Title or Position: OWNER
Credential:
Phone: 301-840-3477