Provider Demographics
NPI:1447654231
Name:PREMIER COMMUNITY SERVICES
Entity type:Organization
Organization Name:PREMIER COMMUNITY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:225-933-0143
Mailing Address - Street 1:PO BOX 1009
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:LA
Mailing Address - Zip Code:70514-1009
Mailing Address - Country:US
Mailing Address - Phone:337-923-0505
Mailing Address - Fax:337-923-0363
Practice Address - Street 1:105 ROSEBUD STREET
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:LA
Practice Address - Zip Code:70514
Practice Address - Country:US
Practice Address - Phone:337-923-0505
Practice Address - Fax:337-923-0363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-22
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
142861374700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374700000XNursing Service Related ProvidersTechnicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1462861Medicaid
LA1468261OtherSTATE OF LOUISIANA PERSONAL CARE ATTENDANT AGENCY