=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457671521
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PREMIER CARE AT HOME INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/10/2010
-----------------------------------------------------
Last Update Date | 02/10/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2000 W MAGNOLIA BLVD STE 208
-----------------------------------------------------
City | BURBANK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91506-1707
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-736-5050
-----------------------------------------------------
Fax | 818-736-5051
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2000 W MAGNOLIA BLVD STE 208
-----------------------------------------------------
City | BURBANK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91506-1707
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-736-5050
-----------------------------------------------------
Fax | 818-736-5051
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | KRISTINE ADIMYAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 818-556-3711
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251G00000X
-----------------------------------------------------
Taxonomy Name | Community Based Hospice Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------