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General NPI Number Information
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NPI Number | 1790390938
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Entity Type | Organization
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Legal Business Name | PREMIER HEALTHCARE SERVICE, LLC
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Dates
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Enumeration Date | 09/14/2020
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Last Update Date | 09/14/2020
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Provider Practice Location Address
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Address Line | 1015 EDEN WAY N STE A
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City | CHESAPEAKE
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State | VA
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Zip | 23320-2787
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Country | US
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Telephone | 757-410-2754
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Fax | 757-410-2763
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Provider Business Mailing Address
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Address Line | 1015 EDEN WAY N STE A
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City | CHESAPEAKE
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State | VA
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Zip | 23320-2787
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Country | US
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Telephone | 757-410-2754
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Fax | 757-410-2763
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | GEORGIANA JOHNSON
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Credential | REGISTERED NURSE
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Telephone | 757-410-2754
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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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 | 385H00000X
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Taxonomy Name | Respite Care
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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 | 251E00000X
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Taxonomy Name | Home Health Agency
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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 | 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 #5
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number |
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License Number State |
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