MEDICARE: PREMIUM HANDS HEALTHCARE SERVICES 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	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
2	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1811720444
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIUM HANDS HEALTHCARE SERVICES LLC

Provider Business Mailing Address
First Line	:	18635 GREENWOOD MEADOW TRL
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77407-4605
Country	:	US
Telephone Number	:	832-310-7771
Fax Number	:

Provider Business Practice Location Address
First Line	:	18635 GREENWOOD MEADOW TRL
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77407-4605
Country	:	US
Telephone Number	:	832-310-7771
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	RUQAYYAH EJALONIBU
Credential	:
Telephone Number	:	832-310-7771

Provider Enumeration Date	:	08/20/2024
Last Update Date	:	09/25/2024

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