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General NPI Number Information
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NPI Number | 1104797182
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Entity Type | Organization
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Legal Business Name | PREMIUM CARE MIHP LLC
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Dates
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Enumeration Date | 09/15/2025
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Last Update Date | 09/16/2025
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Provider Practice Location Address
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Address Line | 29226 ORCHARD LAKE RD STE 140
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City | FARMINGTON HILLS
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State | MI
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Zip | 48334-2990
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Country | US
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Telephone | 248-893-9530
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3251
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City | SOUTHFIELD
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State | MI
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Zip | 48037-3251
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Country | US
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Telephone | 248-893-9530
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Fax |
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Authorized Official
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Title or Position | ORGANIZER
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Name | D'ANNA GILBREATH
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Credential | RN
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Telephone | 248-893-9530
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number |
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License Number State |
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