Healthcare Provider Details

I. General information

NPI: 1265814230
Provider Name (Legal Business Name): TRI-STATE PREMIER HEALTHCARE SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2015
Last Update Date: 06/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 MISTY LAKE LN
BATAVIA OH
45103-1184
US

IV. Provider business mailing address

1250 MISTY LAKE LN
BATAVIA OH
45103-1184
US

V. Phone/Fax

Practice location:
  • Phone: 513-227-9266
  • Fax:
Mailing address:
  • Phone: 513-227-9266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: CLARISSE NYAM
Title or Position: DIRECTOR OF NURSING
Credential: RN
Phone: 513-310-7597