MEDICARE: PREMIERE HOME 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
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1609734979
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIERE HOME CARE LLC

Provider Business Mailing Address
First Line	:	8018 W CAPITOL DR STE 101
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53222-1906
Country	:	US
Telephone Number	:	414-574-0094
Fax Number	:	414-574-0094

Provider Business Practice Location Address
First Line	:	8018 W CAPITOL DR STE 101
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53222-1906
Country	:	US
Telephone Number	:	414-574-0094
Fax Number	:	414-574-0094

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	PORSHA JEFFERSON
Credential	:
Telephone Number	:	414-574-0093

Provider Enumeration Date	:	01/14/2026
Last Update Date	:	01/14/2026

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