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NPI Code Detail

MEDICARE: PREMIUM PERSONAL CARE, LLC

MEDICARE: PREMIUM PERSONAL CARE, LLC
Medicare Provider Information

Scope of Practice

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

# Taxonomy Code Taxonomy License Number License Number State
1253Z00000XIn Home Supportive Care Agency
2385HR2060XChild Intellectual and/or Developmental Disabilities Respite Care
3261QD1600XDevelopmental Disabilities Clinic/Center

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1255928750
Entity Type Code : Organization
Provider Name (Legal Business Name) : PREMIUM PERSONAL CARE, LLC
Provider Business Mailing Address
First Line : 1639 W NORTH BEND RD
Second Line :
City : CINCINNATI
State : OH
Zip : 45224-2023
Country : US
Telephone Number : 513-967-1056
Fax Number :
Provider Business Practice Location Address
First Line : 1639 W NORTH BEND RD
Second Line :
City : CINCINNATI
State : OH
Zip : 45224-2023
Country : US
Telephone Number : 513-967-1056
Fax Number :
Authorized Official
Title or Position : CEO
Name : MICHELLE CAROL JOHNSON
Credential : M.ED
Telephone Number : 513-967-1056
Provider Enumeration Date : 12/30/2020
Last Update Date : 12/30/2020

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