MEDICARE: PREMIUM STANDARD HOME CARE OF MICHIGAN INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	251E00000X	Home Health Agency
2	343900000X	Non-emergency Medical Transport (VAN)
3	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1174390199
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIUM STANDARD HOME CARE OF MICHIGAN INC.

Provider Business Mailing Address
First Line	:	1764 ALEC PL NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30329-3564
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1764 ALEC PL NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30329-3564
Country	:	US
Telephone Number	:	404-545-6888
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MS. GIANINA WALKER
Credential	:
Telephone Number	:	404-545-6888

Provider Enumeration Date	:	12/08/2023
Last Update Date	:	05/27/2026

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