Healthcare Provider Details

I. General information

NPI: 1679941181
Provider Name (Legal Business Name): PREMIUM CARE USA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2015
Last Update Date: 02/12/2026
Certification Date: 02/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10300 EATON PL STE 260
FAIRFAX VA
22030-2255
US

IV. Provider business mailing address

10300 EATON PL STE 260
FAIRFAX VA
22030-2255
US

V. Phone/Fax

Practice location:
  • Phone: 571-620-7556
  • Fax: 571-620-7557
Mailing address:
  • Phone: 571-620-7556
  • Fax: 571-620-7557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: JOHN IVER
Title or Position: CHIEF OPERATING OFFICER
Credential: MSN, RN, CDP
Phone: 571-620-7556