Provider Demographics
NPI:1447684188
Name:PREMIER CARE NURSES OF AMERICA INC
Entity type:Organization
Organization Name:PREMIER CARE NURSES OF AMERICA INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MIRJANA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOFORTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-353-9200
Mailing Address - Street 1:5350 W HILLSBORO BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33073-4396
Mailing Address - Country:US
Mailing Address - Phone:954-933-9005
Mailing Address - Fax:561-353-9201
Practice Address - Street 1:5350 W HILLSBORO BLVD STE 202
Practice Address - Street 2:
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33073-4396
Practice Address - Country:US
Practice Address - Phone:954-933-9005
Practice Address - Fax:561-353-9201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-29
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL30211191251E00000X
253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL690555201Medicaid