Healthcare Provider Details

I. General information

NPI: 1497411847
Provider Name (Legal Business Name): PREMIER QUALITY HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2021
Last Update Date: 11/10/2022
Certification Date: 11/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 BROOKES DR STE 210
HAZELWOOD MO
63042-2740
US

IV. Provider business mailing address

320 BROOKES DR STE 210
HAZELWOOD MO
63042-2740
US

V. Phone/Fax

Practice location:
  • Phone: 917-776-2187
  • Fax:
Mailing address:
  • Phone: 314-274-2776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MS. RASHAD J PREVILLON
Title or Position: CEO
Credential: NP
Phone: 314-274-2776