Provider Demographics
NPI:1487733648
Name:PREMIERE HEALTH SERVICES
Entity type:Organization
Organization Name:PREMIERE HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:RENAUD
Authorized Official - Last Name:MODO MODO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-603-3422
Mailing Address - Street 1:11632 STEWART LN
Mailing Address - Street 2:201
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-2480
Mailing Address - Country:US
Mailing Address - Phone:240-603-3422
Mailing Address - Fax:
Practice Address - Street 1:11632 STEWART LN
Practice Address - Street 2:201
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-2480
Practice Address - Country:US
Practice Address - Phone:240-603-3422
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health