MEDICARE: PREMIER HHC 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	251E00000X	Home Health Agency

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	747143	OTHER	TX	MEDICARE PTAN

General Provider Information

NPI Number	:	1518140615
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIER HHC LLC

Provider Business Mailing Address
First Line	:	1600 PIEDMONT PL
Second Line	:
City	:	CARROLLTON
State	:	TX
Zip	:	75007-5041
Country	:	US
Telephone Number	:	214-483-6800
Fax Number	:	214-483-6802

Provider Business Practice Location Address
First Line	:	1600 PIEDMONT PL
Second Line	:
City	:	CARROLLTON
State	:	TX
Zip	:	75007-5041
Country	:	US
Telephone Number	:	214-483-6800
Fax Number	:	214-483-6802

Authorized Official
Title or Position	:	C.O.O./ALTERNATE ADMIN
Name	:	MR. BETSON JOHN ZACHARIAH
Credential	:
Telephone Number	:	972-890-4743

Provider Enumeration Date	:	12/11/2007
Last Update Date	:	11/25/2009

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Directions to “PREMIER HHC LLC ” Practice Location

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