Basic Information
| Provider Information | |||||||||
| NPI: | 1568707420 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PREMIER CARE OF OHIO LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8444 N 90TH ST STE 100 | ||||||||
| Address2: | |||||||||
| City: | SCOTTSDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852584437 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6022488886 | ||||||||
| FaxNumber: | 6022488999 | ||||||||
| Practice Location | |||||||||
| Address1: | 42 E CRESCENTVILLE RD | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452461302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5136717117 | ||||||||
| FaxNumber: | 5136717110 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/04/2012 | ||||||||
| LastUpdateDate: | 10/20/2021 | ||||||||
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| AuthorizedOfficialLastName: | GAITHER | ||||||||
| AuthorizedOfficialFirstName: | CINDY | ||||||||
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| AuthorizedOfficialTitleorPosition: | REVENUE CYCLE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 4809355755 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 10/20/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0405X | N | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder | 251S00000X | 13361 | OH | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | 13331 | 01 | OH | ODADAS | OTHER |