Healthcare Provider Details

I. General information

NPI: 1033630215
Provider Name (Legal Business Name): PREMIER HEALTH & WELLNESS CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2017
Last Update Date: 06/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4614 WILGROVE MINT HILL RD
MINT HILL NC
28227-3500
US

IV. Provider business mailing address

401 HAWTHORNE LN STE 110-192
CHARLOTTE NC
28204-2484
US

V. Phone/Fax

Practice location:
  • Phone: 704-408-1813
  • Fax:
Mailing address:
  • Phone: 704-606-4166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BD1200X
TaxonomyDialysis Equipment & Supplies (DME)
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MS. BEATRICE SHERRILL
Title or Position: CEO
Credential:
Phone: 704-408-1813