Provider Demographics
NPI:1750707840
Name:SOS PREMIERE
Entity type:Organization
Organization Name:SOS PREMIERE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ALBA
Authorized Official - Middle Name:S
Authorized Official - Last Name:LOGOSSOU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-838-9574
Mailing Address - Street 1:5900 SELLNER LN
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-2214
Mailing Address - Country:US
Mailing Address - Phone:240-838-9574
Mailing Address - Fax:301-327-6302
Practice Address - Street 1:5900 SELLNER LN
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-2214
Practice Address - Country:US
Practice Address - Phone:240-838-9574
Practice Address - Fax:301-327-6302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-12
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health