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General NPI Number Information
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NPI Number | 1164807947
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Entity Type | Organization
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Legal Business Name | PREMIERE SENIOR CARE, LLC
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Dates
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Enumeration Date | 07/22/2015
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Last Update Date | 07/22/2015
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Provider Practice Location Address
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Address Line | 1700 BACK VALLEY RD
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City | TRENTON
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State | GA
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Zip | 30752-4641
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Country | US
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Telephone | 423-847-2422
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 770
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City | TRENTON
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State | GA
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Zip | 30752-0770
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Country | US
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Telephone | 423-847-2422
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Fax |
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Authorized Official
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Title or Position | OWNER/CEO
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Name | MR. STACY LEN WHETZELL
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Credential |
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Telephone | 423-847-2422
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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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