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General NPI Number Information
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NPI Number | 1659090595
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Entity Type | Organization
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Legal Business Name | PREMIUM PERSONAL HOME CARE LLC
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Dates
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Enumeration Date | 08/24/2022
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Last Update Date | 09/21/2022
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Provider Practice Location Address
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Address Line | 3801 N COUNTY ROAD 1140
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City | MIDLAND
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State | TX
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Zip | 79705-9609
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Country | US
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Telephone | 432-270-6074
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Fax | 432-260-6077
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Provider Business Mailing Address
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Address Line | 3801 N COUNTY ROAD 1140
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City | MIDLAND
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State | TX
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Zip | 79705-9609
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Country | US
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Telephone | 432-270-6074
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Fax | 432-260-6077
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Authorized Official
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Title or Position | MEDICAL ASSISTANT
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Name | OSLEIDIS PEREZ LAGO
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Credential |
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Telephone | 432-556-7841
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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