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Organization
PREMIUM HEALTH SERVICES CORPORATION
Active
Organization
PREMIUM HEALTH SERVICES CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAZARO POLANCO RN (DIRECTOR OF NURSING)
(305) 971-0109
Entity
Organization
Contact information
Practice address
12002 SW 128TH CT, SUITE 102, MIAMI, FL 33186-4639
(305) 971-0109
(305) 971-0520
Mailing address
12002 SW 128TH CT, SUITE 102, MIAMI, FL 33186-4639
(305) 971-0109
(305) 971-0520
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
FL
Other
Enumeration date
09/28/2006
Last updated
07/16/2007
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