Healthcare Provider Details

I. General information

NPI: 1992198337
Provider Name (Legal Business Name): PREMIER HOSPICE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2015
Last Update Date: 03/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33259 DEQUINDRE RD SUITE C
TROY MI
48083-4628
US

IV. Provider business mailing address

33259 DEQUINDRE RD SUITE C
TROY MI
48083-4628
US

V. Phone/Fax

Practice location:
  • Phone: 877-580-1885
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MOHAMMAD QAZI
Title or Position: PRESIDENT
Credential: P.T.
Phone: 877-580-1885