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General NPI Number Information
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NPI Number | 1093403487
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Entity Type | Organization
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Legal Business Name | PREMIER HEALTHCARE FIRM
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Dates
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Enumeration Date | 04/25/2023
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Last Update Date | 04/25/2023
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Provider Practice Location Address
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Address Line | 106 ANDREW PL
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City | STERLING
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State | VA
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Zip | 20164-4803
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Country | US
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Telephone | 240-907-1343
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Fax |
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Provider Business Mailing Address
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Address Line | 585 GROVE ST STE 145
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City | HERNDON
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State | VA
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Zip | 20170-4791
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ACCOUNT MANAGER
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Name | MARK WALLACE
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Credential |
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Telephone | 703-546-6626
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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