Basic Information
| Provider Information | |||||||||
| NPI: | 1972860781 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PREMISE HEALTH EMPLOYER SOLUTIONS LLC | ||||||||
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| OtherOrganizationName: | TAKE CARE EMPLOYER SOLUTIONS LLC | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5500 MARYLAND WAY STE 400 | ||||||||
| Address2: | |||||||||
| City: | BRENTWOOD | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370277048 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8444077557 | ||||||||
| FaxNumber: | 6716493872 | ||||||||
| Practice Location | |||||||||
| Address1: | 523 CHALAN PASAHERU | ||||||||
| Address2: | OLD COMMUTER TERMINAL | ||||||||
| City: | TAMUNING | ||||||||
| State: | GU | ||||||||
| PostalCode: | 96913 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6416217670 | ||||||||
| FaxNumber: | 6716493872 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/18/2012 | ||||||||
| LastUpdateDate: | 10/09/2017 | ||||||||
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| AuthorizedOfficialLastName: | WRIGHT | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | SECRETARY/GENERAL COUNSEL | ||||||||
| AuthorizedOfficialTelephone: | 6155775893 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QU0200X | N | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care | 261QM1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty |
No ID Information.