Healthcare Provider Details

I. General information

NPI: 1881421642
Provider Name (Legal Business Name): PREMIER NURSING CARE AGENCY LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2024
Last Update Date: 11/20/2024
Certification Date: 11/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5707 S AUGUSTA ST
SEATTLE WA
98178-2814
US

IV. Provider business mailing address

5707 S AUGUSTA ST
SEATTLE WA
98178-2814
US

V. Phone/Fax

Practice location:
  • Phone: 206-898-1335
  • Fax:
Mailing address:
  • Phone: 206-898-1335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number StateNULL

VIII. Authorized Official

Name: FORSON ADDAE BOATENG
Title or Position: MANAGER
Credential: RN
Phone: 206-898-1335