{
"Npi": {
"NPI": "1689527475",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "PREMIUM HEALTHCARE SERVICES LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "1040 90TH ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WEST DES MOINES",
"MailingAddressStateName": "IA",
"MailingAddressPostalCode": "50266-3306",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": null,
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1040 90TH ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "WEST DES MOINES",
"PracticeLocationAddressStateName": "IA",
"PracticeLocationAddressPostalCode": "50266-3306",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "301-683-4148",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "02/19/2026",
"LastUpdateDate": "02/19/2026",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "TABI DEISRAEL",
"AuthorizedOfficialFirstName": "IMMACULATE",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "CO-OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "301-683-4148",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "177F00000X",
"TaxonomyName": "Lodging Provider",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "311500000X",
"TaxonomyName": "Alzheimer Center (Dementia Center)",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "311ZA0620X",
"TaxonomyName": "Adult Care Home Facility",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "311Z00000X",
"TaxonomyName": "Custodial Care Facility",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}