MEDICARE: PREMIER HOME HEALTH CARE, INC.

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	:	1780603134
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIER HOME HEALTH CARE, INC.

Provider Business Mailing Address
First Line	:	1016 E. SHAWNTEL SMITH BOULEVARD
Second Line	:
City	:	MULDROW
State	:	OK
Zip	:	74948
Country	:	US
Telephone Number	:	918-427-1900
Fax Number	:	918-427-9967

Provider Business Practice Location Address
First Line	:	1016 E. SHAWNTEL SMITH BOULEVARD
Second Line	:	SUITE 2
City	:	MULDROW
State	:	OK
Zip	:	74948
Country	:	US
Telephone Number	:	918-427-1900
Fax Number	:	877-700-6210

Authorized Official
Title or Position	:	ADMINISTRATOR/ OWNER
Name	:	MARY RENEE ROGERS
Credential	:	REGISTERED NURSE
Telephone Number	:	918-427-1900

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	05/19/2020

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