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General NPI Number Information
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NPI Number | 1871471532
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Entity Type | Organization
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Legal Business Name | PREMIUM COMMUNITY CARE PLLC
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Dates
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Enumeration Date | 08/21/2025
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Last Update Date | 08/21/2025
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Provider Practice Location Address
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Address Line | 14556 N PENNSYLVANIA AVE APT 101
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City | OKLAHOMA CITY
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State | OK
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Zip | 73134-6145
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Country | US
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Telephone | 701-373-6394
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Fax |
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Provider Business Mailing Address
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Address Line | 901 10TH ST S
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City | FARGO
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State | ND
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Zip | 58103-3101
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Country | US
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Telephone | 701-373-6394
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MADELEINE ATEMKENG NSO NANA
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Credential |
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Telephone | 218-892-5964
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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