Healthcare Provider Details

I. General information

NPI: 1184375362
Provider Name (Legal Business Name): PREMIERE QUALITY HEALTH CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2022
Last Update Date: 12/07/2023
Certification Date: 12/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12048 GRAND RIVER AVE
DETROIT MI
48204-1836
US

IV. Provider business mailing address

12048 GRAND RIVER AVE
DETROIT MI
48204-1836
US

V. Phone/Fax

Practice location:
  • Phone: 313-635-5978
  • Fax: 313-635-2171
Mailing address:
  • Phone: 313-491-0003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: MS. ESHA DUSHON PRICE
Title or Position: NURSE PRACTITIONER
Credential: NP
Phone: 313-635-5978