=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447624010
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PREMIER HOME CARE SERVICES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/19/2015
-----------------------------------------------------
Last Update Date | 11/19/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 112 W WASHINGTON ST
-----------------------------------------------------
City | SUFFOLK
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23434-5246
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-539-0888
-----------------------------------------------------
Fax | 757-539-5999
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 112 W WASHINGTON ST
-----------------------------------------------------
City | SUFFOLK
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23434-5246
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-539-0888
-----------------------------------------------------
Fax | 757-539-5999
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINSTRATOR
-----------------------------------------------------
Name | MS. LISA TROTTER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 757-376-5839
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------