Provider Demographics
NPI:1548863293
Name:PREMIUM CARE HEALTH SERVICES, LLC
Entity type:Organization
Organization Name:PREMIUM CARE HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CFO
Authorized Official - Prefix:
Authorized Official - First Name:LUISA
Authorized Official - Middle Name:
Authorized Official - Last Name:RONDON-LASSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-336-6275
Mailing Address - Street 1:10300 SW 72ND ST STE 200
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-3040
Mailing Address - Country:US
Mailing Address - Phone:305-336-6275
Mailing Address - Fax:786-254-5162
Practice Address - Street 1:10300 SW 72ND ST STE 200
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3040
Practice Address - Country:US
Practice Address - Phone:305-336-6275
Practice Address - Fax:786-254-5162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health