Healthcare Provider Details

I. General information

NPI: 1336207299
Provider Name (Legal Business Name): PREMIEANT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 ISOM ROAD STE 285
SAN ANTONIO TX
78216
US

IV. Provider business mailing address

1110 WEST WILLIAM CANNON BUILDING 2
AUSTIN TX
78745
US

V. Phone/Fax

Practice location:
  • Phone: 512-916-1632
  • Fax: 512-916-1639
Mailing address:
  • Phone: 512-916-1632
  • Fax: 512-916-1639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. DENNIS R LATIMER
Title or Position: CEO
Credential:
Phone: 512-916-1632