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General NPI Number Information
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NPI Number | 1154185395
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Entity Type | Organization
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Legal Business Name | PREMIUM STANDARD HOME CARE OF OHIO
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Dates
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Enumeration Date | 02/08/2024
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Last Update Date | 02/08/2024
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Provider Practice Location Address
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Address Line | 1764 ALEC PLACE
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City | ATLANTA
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State | GA
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Zip | 30329
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Country | US
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Telephone | 404-545-6888
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Fax |
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Provider Business Mailing Address
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Address Line | 815 SUPERIOR AVE E STE 1618
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City | CLEVELAND
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State | OH
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Zip | 44114-2709
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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 | OWNER
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Name | MS. GIANINA WALKER
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Credential |
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Telephone | 404-545-6888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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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 | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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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 | 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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