MEDICARE: PREMIER CARE SERVICES, 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
1	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1376054940
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIER CARE SERVICES, LLC

Provider Business Mailing Address
First Line	:	17740 PRESTON RD STE 200D
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75252-5840
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	17740 PRESTON RD STE 200D
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75252-5840
Country	:	US
Telephone Number	:	214-200-5267
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	DR. STEPHEN J LARRY
Credential	:
Telephone Number	:	214-200-5267

Provider Enumeration Date	:	10/23/2017
Last Update Date	:	10/23/2017

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Directions to “PREMIER CARE SERVICES, LLC ” Practice Location

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