Healthcare Provider Details

I. General information

NPI: 1790390938
Provider Name (Legal Business Name): PREMIER HEALTHCARE SERVICE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2020
Last Update Date: 09/14/2020
Certification Date: 09/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 EDEN WAY N STE A
CHESAPEAKE VA
23320-2787
US

IV. Provider business mailing address

1015 EDEN WAY N STE A
CHESAPEAKE VA
23320-2787
US

V. Phone/Fax

Practice location:
  • Phone: 757-410-2754
  • Fax: 757-410-2763
Mailing address:
  • Phone: 757-410-2754
  • Fax: 757-410-2763

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 Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: GEORGIANA JOHNSON
Title or Position: ADMINISTRATOR
Credential: REGISTERED NURSE
Phone: 757-410-2754