Organization
PREMIUM PERSONAL CARE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELLE CAROL JOHNSON M.ED (CEO)
(513) 967-1056
Entity
Organization
Contact information
Practice address
1639 W NORTH BEND RD, CINCINNATI, OH 45224-2023
(513) 967-1056
Mailing address
1639 W NORTH BEND RD, CINCINNATI, OH 45224-2023
(513) 967-1056
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
—
—
261QD1600X
Developmental Disabilities Clinic/Center
Primary
—
—
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3124185
—
OH
Enumeration date
12/30/2020
Last updated
12/30/2020
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