=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518151810
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PREMIERE HOME HEALTH SERVICES INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/29/2007
-----------------------------------------------------
Last Update Date | 10/16/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3939 BEECHWOOD PL
-----------------------------------------------------
City | SEAFORD
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11783-2026
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-509-6291
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3939 BEECHWOOD PL
-----------------------------------------------------
City | SEAFORD
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11783-2026
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-509-6291
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MYRA MONSALES CABAHUG
-----------------------------------------------------
Credential | P.T
-----------------------------------------------------
Telephone | 516-509-6291
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 015778-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------