Provider Demographics
NPI:1033092697
Name:PREMIUM HEALTHCARE SERVICES LLC
Entity type:Organization
Organization Name:PREMIUM HEALTHCARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NOSIMOT
Authorized Official - Middle Name:ADENIKE
Authorized Official - Last Name:BUHARI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-412-8515
Mailing Address - Street 1:6702 CHAPEL DALE RD
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720-5217
Mailing Address - Country:US
Mailing Address - Phone:617-412-8515
Mailing Address - Fax:
Practice Address - Street 1:6702 CHAPEL DALE RD
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20720-5217
Practice Address - Country:US
Practice Address - Phone:617-412-8515
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-30
Last Update Date:2025-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
No385H00000XRespite Care FacilityRespite Care