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NPI Code Detail

MEDICARE: PREMIER CARE OF OHIO LLC

MEDICARE: PREMIER CARE OF OHIO 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
1261QR0405XSubstance Use Disorder Rehabilitation Clinic/Center
2101YA0400XAddiction (Substance Use Disorder) Counselor
3251S00000XCommunity/Behavioral Health Agency13361OH
4261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)
5261QM2800XMethadone Clinic

General Provider Information

NPI Number : 1568707420
Entity Type Code : Organization
Provider Name (Legal Business Name) : PREMIER CARE OF OHIO LLC
Provider Business Mailing Address
First Line : 8444 N 90TH ST STE 100
Second Line :
City : SCOTTSDALE
State : AZ
Zip : 85258-4437
Country : US
Telephone Number : 602-248-8886
Fax Number : 602-248-8999
Provider Business Practice Location Address
First Line : 42 EAST CRESCENTVILLE ROAD
Second Line :
City : CINCINNATI
State : OH
Zip : 45246-1302
Country : US
Telephone Number : 513-671-7117
Fax Number : 513-671-7110
Authorized Official
Title or Position : VP REVENUE CYCLE MGMT
Name : CINDY GAITHER
Credential :
Telephone Number : 602-248-8886
Provider Enumeration Date : 12/04/2012
Last Update Date : 07/16/2024

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Directions to “PREMIER CARE OF OHIO LLC ” Practice Location

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