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General NPI Number Information
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NPI Number | 1689527475
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Entity Type | Organization
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Legal Business Name | PREMIUM HEALTHCARE SERVICES LLC
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Dates
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Enumeration Date | 02/19/2026
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Last Update Date | 02/19/2026
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Provider Practice Location Address
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Address Line | 1040 90TH ST
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City | WEST DES MOINES
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State | IA
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Zip | 50266-3306
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Country | US
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Telephone | 301-683-4148
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Fax |
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Provider Business Mailing Address
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Address Line | 1040 90TH ST
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City | WEST DES MOINES
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State | IA
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Zip | 50266-3306
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | IMMACULATE TABI DEISRAEL
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Credential |
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Telephone | 301-683-4148
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 177F00000X
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Taxonomy Name | Lodging Provider
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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 | 311500000X
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Taxonomy Name | Alzheimer Center (Dementia Center)
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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 | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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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 | 311Z00000X
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Taxonomy Name | Custodial Care Facility
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License Number |
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License Number State |
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