Provider Demographics
NPI:1043459860
Name:PREMIUM HEALTH AT HOME INC
Entity type:Organization
Organization Name:PREMIUM HEALTH AT HOME INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-742-8710
Mailing Address - Street 1:1262 N 22ND ST UNIT B
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82072-5307
Mailing Address - Country:US
Mailing Address - Phone:307-745-8710
Mailing Address - Fax:307-459-1349
Practice Address - Street 1:1262 N 22ND ST UNIT B
Practice Address - Street 2:
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82072-5307
Practice Address - Country:US
Practice Address - Phone:307-745-8710
Practice Address - Fax:307-459-1349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-18
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY251B00000X
251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251B00000XAgenciesCase Management