MEDICARE: PREMIUM HEALTHCARE SOLUTIONS, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	163WH0200X	Home Health Registered Nurse
2	174200000X	Meals Provider
3	253Z00000X	In Home Supportive Care Agency
4	302R00000X	Health Maintenance Organization
5	311ZA0620X	Adult Care Home Facility
6	343900000X	Non-emergency Medical Transport (VAN)
7	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1245826296
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIUM HEALTHCARE SOLUTIONS, LLC

Provider Business Mailing Address
First Line	:	3735 WOODRIDGE RD
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44121-1860
Country	:	US
Telephone Number	:	216-609-5594
Fax Number	:

Provider Business Practice Location Address
First Line	:	3735 WOODRIDGE RD
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44121-1860
Country	:	US
Telephone Number	:	216-609-5594
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DANITA SWINNEY
Credential	:	RN
Telephone Number	:	216-675-1550

Provider Enumeration Date	:	12/14/2020
Last Update Date	:	12/14/2020

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