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General NPI Number Information
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NPI Number | 1043006687
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Entity Type | Organization
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Legal Business Name | PREMIERONE PLUS CBAS
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Dates
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Enumeration Date | 04/18/2025
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Last Update Date | 07/14/2025
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Provider Practice Location Address
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Address Line | 1035 N MAGNOLIA AVE
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City | ANAHEIM
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State | CA
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Zip | 92801-3116
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Country | US
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Telephone | 714-495-4392
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Fax | 714-388-3354
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Provider Business Mailing Address
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Address Line | 6800 LINCOLN AVE STE 200
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City | BUENA PARK
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State | CA
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Zip | 90620-4164
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Country | US
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Telephone | 144-954-3927
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Fax | 714-388-3354
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Authorized Official
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Title or Position | MANAGER
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Name | JOSEPH PARK
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Credential |
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Telephone | 714-495-4392
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174200000X
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Taxonomy Name | Meals Provider
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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