Provider Demographics
NPI:1902257686
Name:PREMIER HOME CARE INC
Entity Type:Organization
Organization Name:PREMIER HOME CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SERGEY
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-322-8063
Mailing Address - Street 1:10295 CHAUCER AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63114-2325
Mailing Address - Country:US
Mailing Address - Phone:314-322-8063
Mailing Address - Fax:314-423-1243
Practice Address - Street 1:1515 N WARSON RD
Practice Address - Street 2:SUIT 249
Practice Address - City:OLIVETTE
Practice Address - State:MO
Practice Address - Zip Code:63132-1111
Practice Address - Country:US
Practice Address - Phone:314-322-8063
Practice Address - Fax:314-423-1243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-23
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOLC001446772251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health