MEDICARE: PREMIER HEALTH CARE SERVICES, L.C.

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	385H00000X	Respite Care	12547	UT

General Provider Information

NPI Number	:	1508054370
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIER HEALTH CARE SERVICES, L.C.

Provider Business Mailing Address
First Line	:	2179 W 1800 N
Second Line	:	SUITE D
City	:	CLINTON
State	:	UT
Zip	:	84015-7900
Country	:	US
Telephone Number	:	801-825-3582
Fax Number	:	801-825-8536

Provider Business Practice Location Address
First Line	:	2179 W 1800 N
Second Line	:	SUITE D
City	:	CLINTON
State	:	UT
Zip	:	84015-7900
Country	:	US
Telephone Number	:	801-825-3582
Fax Number	:	801-825-8536

Authorized Official
Title or Position	:	OWNER
Name	:	MARK FLINDERS
Credential	:
Telephone Number	:	801-825-3582

Provider Enumeration Date	:	10/05/2007
Last Update Date	:	10/05/2007

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