Contract Details
Facility name
Premium Nursing Services
Provider ID
P000002348
NPI
1962680397
Tax ID
770716531
Effective Date
8/20/2009
Last Updated
7/8/2013
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
80.00
Location Details
Address
4118 Wellington Hills Lane
Snellville, GA 30039
United States
County
Gwinnett
Phone
4044380813 (Phone)
Billing Details
Address
PO Box 391183
Snellville, GA 30039
Specialty Type
Home Health
Map
Address