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General NPI Number Information
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NPI Number | 1285291328
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Entity Type | Organization
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Legal Business Name | PREMIER SUPPORTS, LLC
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Dates
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Enumeration Date | 05/23/2019
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Last Update Date | 11/25/2024
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Provider Practice Location Address
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Address Line | 100 RANDOLPH RD STE 8
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City | SOMERSET
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State | NJ
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Zip | 08873-1384
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Country | US
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Telephone | 512-628-1553
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Fax | 512-628-1553
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Provider Business Mailing Address
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Address Line | 6600 FRANCE AVE S STE 350
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City | EDINA
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State | MN
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Zip | 55435-1810
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Country | US
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Telephone | 800-388-5150
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Fax | 952-922-6885
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Authorized Official
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Title or Position | VP & SR. ASST GENERAL COUNSEL
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Name | MARY PATRICIA RODENBERG-ROBERTS
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Credential |
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Telephone | 952-836-2234
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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