Healthcare Provider Details

I. General information

NPI: 1013910793
Provider Name (Legal Business Name): PREMIER SUPPORT SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 06/20/2024
Certification Date: 06/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2482 BRIGHTS PIKE
MORRISTOWN TN
37814-6315
US

IV. Provider business mailing address

2482 BRIGHTS PIKE
MORRISTOWN TN
37814-6315
US

V. Phone/Fax

Practice location:
  • Phone: 423-587-8771
  • Fax: 423-587-8773
Mailing address:
  • Phone: 423-587-8771
  • Fax: 423-587-8773

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License NumberL000000006169
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number0000000010
License Number StateTN

VIII. Authorized Official

Name: RANDALL FRYE
Title or Position: PRESIDENT
Credential:
Phone: 276-494-8119