Healthcare Provider Details

I. General information

NPI: 1295517928
Provider Name (Legal Business Name): PREMIER HEALTH NETWORK, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2023
Last Update Date: 11/15/2023
Certification Date: 11/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20998 WESTHAVEN AVE
SOUTHFIELD MI
48075-7931
US

IV. Provider business mailing address

20998 WESTHAVEN AVE
SOUTHFIELD MI
48075-7931
US

V. Phone/Fax

Practice location:
  • Phone: 313-208-1685
  • Fax:
Mailing address:
  • Phone: 313-208-1685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: TANESHA SMITH
Title or Position: DIRECTOR
Credential:
Phone: 313-208-1685