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General NPI Number Information
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NPI Number | 1841025350
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Entity Type | Organization
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Legal Business Name | PREMIUM HOME HEALTH
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Dates
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Enumeration Date | 09/04/2024
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Last Update Date | 09/04/2024
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Provider Practice Location Address
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Address Line | 881 DECLARATION DRIVE
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City | PITTSBORO
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State | IN
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Zip | 46167
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Country | US
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Telephone | 317-744-3022
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Fax |
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Provider Business Mailing Address
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Address Line | 881 DECLARATION DRIVE
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City | PITTSBORO
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State | IN
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Zip | 46167
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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 | ALTERNATE ADMINISTRATOR
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Name | CHIKE NWOKEDI
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Credential |
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Telephone | 317-469-3360
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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