Provider Demographics
NPI:1235232695
Name:PREMIEANT INC
Entity type:Organization
Organization Name:PREMIEANT INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:R
Authorized Official - Last Name:LATIMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-916-1632
Mailing Address - Street 1:1110 WEST WILLIAM CANNON
Mailing Address - Street 2:BUILDING 2
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745
Mailing Address - Country:US
Mailing Address - Phone:512-916-1632
Mailing Address - Fax:512-916-1639
Practice Address - Street 1:7509 WESTGATE BLVD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745
Practice Address - Country:US
Practice Address - Phone:512-916-1632
Practice Address - Fax:512-916-1639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7475315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities