Healthcare Provider Details

I. General information

NPI: 1053114744
Provider Name (Legal Business Name): PREMIUM STANDARD HOME HEALTH OF OHIO INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2025
Last Update Date: 03/29/2025
Certification Date: 03/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20525 DETROIT RD STE 7
ROCKY RIVER OH
44116-2444
US

IV. Provider business mailing address

2231 HUNTERS GREEN DR
LAWRENCEVILLE GA
30043-5182
US

V. Phone/Fax

Practice location:
  • Phone: 317-453-6323
  • Fax:
Mailing address:
  • Phone: 317-453-6323
  • 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 Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. GIANINA WALKER
Title or Position: OWNER
Credential:
Phone: 317-453-6323