Provider Demographics
NPI:1477433688
Name:PREMIUM COMMUNITY SERVICES
Entity type:Organization
Organization Name:PREMIUM COMMUNITY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:JAKAUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-669-0444
Mailing Address - Street 1:1354 HANCOCK ST STE 208
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-5109
Mailing Address - Country:US
Mailing Address - Phone:617-669-0444
Mailing Address - Fax:
Practice Address - Street 1:1354 HANCOCK ST STE 208
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-5109
Practice Address - Country:US
Practice Address - Phone:617-669-0444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-08
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty