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General NPI Number Information
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NPI Number | 1184375362
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Entity Type | Organization
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Legal Business Name | PREMIERE QUALITY HEALTH CENTER INC
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Dates
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Enumeration Date | 01/10/2022
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Last Update Date | 12/07/2023
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Provider Practice Location Address
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Address Line | 12048 GRAND RIVER AVE
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City | DETROIT
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State | MI
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Zip | 48204-1836
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Country | US
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Telephone | 313-635-5978
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Fax | 313-635-2171
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Provider Business Mailing Address
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Address Line | 12048 GRAND RIVER AVE
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City | DETROIT
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State | MI
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Zip | 48204-1836
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Country | US
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Telephone | 313-491-0003
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | MS. ESHA DUSHON PRICE
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Credential | NP
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Telephone | 313-635-5978
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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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 | 374U00000X
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Taxonomy Name | Home Health Aide
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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