Healthcare Provider Details

I. General information

NPI: 1205511698
Provider Name (Legal Business Name): PREMIUM MOVING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2023
Last Update Date: 06/21/2023
Certification Date: 06/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7652 215TH ST W
LAKEVILLE MN
55044-8984
US

IV. Provider business mailing address

949 SCHALLER DR S
MAPLEWOOD MN
55119-5843
US

V. Phone/Fax

Practice location:
  • Phone: 651-461-3040
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number State

VIII. Authorized Official

Name: CHESTER SACKIE
Title or Position: PRESIDENT
Credential:
Phone: 651-757-5135