MEDICARE: PREMIER SERVICES AT HOME 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	311Z00000X	Custodial Care Facility
2	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1629791934
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIER SERVICES AT HOME LLC

Provider Business Mailing Address
First Line	:	121 BRICK KILN RD UNIT 214
Second Line	:
City	:	CHELMSFORD
State	:	MA
Zip	:	01824-3259
Country	:	US
Telephone Number	:	978-710-1701
Fax Number	:

Provider Business Practice Location Address
First Line	:	121 BRICK KILN RD UNIT 214
Second Line	:
City	:	CHELMSFORD
State	:	MA
Zip	:	01824-3259
Country	:	US
Telephone Number	:	978-710-1701
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. VICTOR MWAURAH
Credential	:
Telephone Number	:	978-654-1701

Provider Enumeration Date	:	09/21/2022
Last Update Date	:	05/01/2025

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