Premium Life Care, Inc.,

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

Legal business name

PREMIUM LIFE CARE, INC.,

Doing business as

BrightStar Care of San Luis Obispo

Practice address

3220 S Higuera St
Suite 315
San Luis Obispo, CA 93401-6987

Phone

(805) 548-8811

Fax

(805) 242-0676

NPI assigned

Jan 18, 2009

Last updated

Sep 1, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mechell A Vieira

Title

President

Phone

(805) 548-8811

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• BrightStar Care of San Luis Obispo Doing business as

Electronic endpoints 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1232236800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598918400000",
    "number": "1255578803",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3220 S HIGUERA ST",
            "address_2": "SUITE 315",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934016987",
            "telephone_number": "805-548-8811",
            "fax_number": "805-715-3460"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3220 S HIGUERA ST",
            "address_2": "SUITE 315",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934016987",
            "telephone_number": "805-548-8811",
            "fax_number": "805-242-0676"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIUM LIFE CARE, INC.,",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-01-18",
        "last_updated": "2020-09-01",
        "certification_date": "2020-09-01",
        "status": "A",
        "authorized_official_last_name": "VIEIRA",
        "authorized_official_first_name": "MECHELL",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "805-548-8811"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE HOME HEALTH AGENCY LICENSE",
            "identifier": "550003349",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "8052420676",
            "affiliation": "N",
            "endpointDescription": "Secure Fax",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "3220 S Higuera St",
            "address_2": "Suite 315",
            "city": "San Luis Obispo",
            "state": "CA",
            "country_code": "US",
            "postal_code": "934016987",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "BrightStar Care of San Luis Obispo",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Home Health Agency in San Luis Obispo, CA
• Providers in San Luis Obispo, CA by specialty
• Home Health Agency in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.