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General NPI Number Information
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NPI Number | 1619854346
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Entity Type | Organization
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Legal Business Name | PREMIUM NATION ENTERPRISE LLC
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Dates
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Enumeration Date | 08/15/2025
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Last Update Date | 08/16/2025
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Provider Practice Location Address
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Address Line | 20226 CHULA VISTA DR
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City | CYPRESS
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State | TX
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Zip | 77433-8352
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Country | US
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Telephone | 281-905-4487
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Fax |
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Provider Business Mailing Address
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Address Line | 20226 CHULA VISTA DR
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City | CYPRESS
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State | TX
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Zip | 77433-8352
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Country | US
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Telephone | 281-905-4487
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CHELKIE DOUGLAS
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Credential |
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Telephone | 281-905-4487
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QD1600X
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Taxonomy Name | Developmental Disabilities Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 3104A0630X
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Taxonomy Name | Assisted Living Facility (Behavioral Disturbances)
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 315P00000X
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Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #10
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #11
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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