=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811297674
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PREMIER SERVANTS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/27/2010
-----------------------------------------------------
Last Update Date | 10/17/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 106 DEBUSK LN
-----------------------------------------------------
City | KNOXVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37922-2021
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 865-531-4833
-----------------------------------------------------
Fax | 865-531-4835
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 106 DEBUSK LN
-----------------------------------------------------
City | KNOXVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37922-2021
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 865-531-4833
-----------------------------------------------------
Fax | 865-531-4835
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/DIRECTOR
-----------------------------------------------------
Name | DANIEL DUWAYNE POPE
-----------------------------------------------------
Credential | MBA
-----------------------------------------------------
Telephone | 865-531-4833
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number | L000000006469
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------