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General NPI Number Information
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NPI Number | 1578560801
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Entity Type | Organization
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Legal Business Name | PREMIER HOME HEALTH LLC
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Dates
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Enumeration Date | 07/01/2005
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Last Update Date | 05/08/2012
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Provider Practice Location Address
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Address Line | 504 N BRADNER AVE
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City | MARION
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State | IN
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Zip | 46952-2477
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Country | US
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Telephone | 765-662-0491
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Fax | 765-662-0498
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Provider Business Mailing Address
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Address Line | 504 N BRADNER AVE
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City | MARION
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State | IN
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Zip | 46952-2477
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Country | US
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Telephone | 765-662-0491
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Fax | 765-662-0498
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. ERIC WALTS
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Credential | MBA
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Telephone | 765-662-4091
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 05010001-1
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License Number State | IN
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