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Organization
PREMIUM LIFE CARE, INC.,
Active
Organization
PREMIUM LIFE CARE, INC.,
Active
Other names
BrightStar Care of San Luis Obispo
Organization subpart
No
Provider details
NPI number
Authorized official
MECHELL A VIEIRA (PRESIDENT)
(805) 548-8811
Entity
Organization
Contact information
Practice address
3220 S HIGUERA ST, SUITE 315, SAN LUIS OBISPO, CA 93401-6987
(805) 548-8811
(805) 242-0676
Mailing address
3220 S HIGUERA ST, SUITE 315, SAN LUIS OBISPO, CA 93401-6987
(805) 548-8811
(805) 715-3460
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
550003349
STATE HOME HEALTH AGENCY LICENSE
CA
Enumeration date
01/18/2009
Last updated
09/01/2020
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