Provider Demographics
NPI:1447942339
Name:PREMIUM HOME SERVICES LLC
Entity type:Organization
Organization Name:PREMIUM HOME SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:IDIAGHE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-853-0441
Mailing Address - Street 1:12134 CARRIAGE STONE DR
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-8501
Mailing Address - Country:US
Mailing Address - Phone:317-853-0441
Mailing Address - Fax:
Practice Address - Street 1:12134 CARRIAGE STONE DR
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-8501
Practice Address - Country:US
Practice Address - Phone:317-853-0441
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care