# PREMIUM HOME HEALTHCARE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1336030568
- **Authorized official:** NICHOLAS JOHNSON (OWNER)
- **Authorized official phone:** (314) 379-9187

## Contact information

- **Practice address:** 1921 CORA AVE, SAINT LOUIS, MO 63113-2223
- **Practice address phone:** (314) 379-9187
- **Mailing address:** 922 SOUTHERNSIDE LN, O FALLON, MO 63368-8433

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251E00000X | Home Health Agency | — | NULL | Yes |

## Other

- **Enumeration date:** 07/15/2025
- **Last updated:** 07/15/2025