Organization
PREMIER GROUP HOMES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANGELA MACIVER (CEO)
(813) 245-8416
Entity
Organization
Contact information
Practice address
2433 9TH AVE N, SAINT PETERSBURG, FL 33713-6834
(813) 245-8416
Mailing address
2433 9TH AVE N, SAINT PETERSBURG, FL 33713-6834
Taxonomy
Speciality
Code
Description
License number
State
261QD1600X
Developmental Disabilities Clinic/Center
Primary
—
—
Other
Enumeration date
07/24/2018
Last updated
07/24/2018
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