Healthcare Provider Details

I. General information

NPI: 1285291328
Provider Name (Legal Business Name): PREMIER SUPPORTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2019
Last Update Date: 11/25/2024
Certification Date: 11/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 RANDOLPH RD STE 8
SOMERSET NJ
08873-1384
US

IV. Provider business mailing address

6600 FRANCE AVE S STE 350
EDINA MN
55435-1810
US

V. Phone/Fax

Practice location:
  • Phone: 512-628-1553
  • Fax: 512-628-1553
Mailing address:
  • Phone: 800-388-5150
  • Fax: 952-922-6885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MARY PATRICIA RODENBERG-ROBERTS
Title or Position: VP & SR. ASST GENERAL COUNSEL
Credential:
Phone: 952-836-2234