Active NPI
Premier Healthcare Services, LLC
- Home Health Agency
- Victorville, CA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Home Health Agency
- Legal business name
- PREMIER HEALTHCARE SERVICES, LLC
- Practice address
- 12401 Hesperia Rd Ste 8
Victorville, CA 92395-5844 - Phone
- (888) 720-3826
- Fax
- (888) 712-3057
- NPI assigned
- Feb 10, 2014
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Matthew Buckhalter
- Title
- Cfo
- Phone
- (470) 464-8000
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Agency | 251E00000X | Primary |
Addresses
Primary practice location
12401 Hesperia Rd Ste 8
Victorville, CA 92395-5844
Mailing address
400 Interstate North Pkwy SE Ste 1600
Atlanta, GA 30339-5047
Phone (470) 464-8000
Other names 1
- Aveanna Healthacare
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20140402001085 | CA | Part A Provider - Home Health Agency | 2264517697 | Practice locations: Victorville, CA |
Home health agency certification: CCN 059747
- Legal name
- PREMIER HEALTHCARE SERVICES, LLC
- Doing business as
- AVEANNA HEALTHCARE
- Certification status
- Active
- Provider type (POS)
- Home health agency
- Participating since
- Feb 15, 2016
- Last certification
- Feb 13, 2019
- Ownership / control type
- Proprietary
- Organization structure
- LLC
- Incorporated
- Nov 7, 2005 in CA
- Enrollment address
- 12401 Hesperia Rd
Ste 8
Victorville, CA 92395-5844
Other NPIs with the same Medicare PAC ID 15
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
Care Compare: Home health agency
Medicare Care Compare- Listed as
- Aveanna Healthcare
- Ownership
- Proprietary
- Certified
- Feb 15, 2016
- Medicare certification status
- Active
- Services
- Nursing, Medical social, Home health aide
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 05D2078281 | Premier Healthcare Services LLC | Certificate of waiver | May 22, 2028 |
National Provider Directory
National Provider Directory- Tax ID family
- Premier Healthcare Services
Other organizations with this tax ID 23
Organizations that report the same tax identification number in the National Provider Directory.
-
- Home Health Agency
- Stevenson Ranch, CA
- NPI 1093946238
-
- Home Health Agency
- West Covina, CA
- NPI 1104058122
-
- Home Health Agency
- Sherman Oaks, CA
- NPI 1114159381
-
- Home Health Agency
- San Jose, CA
- NPI 1114246816
-
- Home Health Agency
- Torrance, CA
- NPI 1134306970
-
- Home Health Agency
- Sacramento, CA
- NPI 1275764417
-
- Home Health Agency
- Pasadena, CA
- NPI 1295089209
-
- Home Health Agency
- Orange, CA
- NPI 1326292897
-
- Home Health Agency
- Alameda, CA
- NPI 1396064093
-
- Home Health Agency
- Bakersfield, CA
- NPI 1407280563
-
- Home Health Agency
- San Diego, CA
- NPI 1437385010
-
- Home Health Agency
- Culver City, CA
- NPI 1437400165
Locations
12401 Hesperia Rd
Ste 8
Victorville, CA 92395
Phone (442) 300-9788
Ownership & related parties
All disclosed owners & managing parties 14
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| J.H. Whitney VII LP | 5% Or Greater Indirect Ownership Interest | Jul 1, 2018 | 6.18% |
| Psa Healthcare Investment Holding LLC | 5% Or Greater Indirect Ownership Interest | Jul 1, 2018 | 7.14% |
| Aveanna Healthcare LLC | 5% Or Greater Direct Ownership Interest | Jul 1, 2018 | 100% |
| Aveanna Healthcare Intermediate Holdings LLC | 5% Or Greater Indirect Ownership Interest | Jul 1, 2018 | 100% |
| Aveanna Healthcare Holdings Inc | 5% Or Greater Indirect Ownership Interest | Jul 1, 2018 | 100% |
| Nut Tree Master Fund LP | 5% Or Greater Indirect Ownership Interest | Dec 31, 2023 | 5.69% |
| Matthew Buckhalter | Corporate Officer | Jul 7, 2023 | |
| Corporate Director | Jul 7, 2023 | ||
| Hamilton Lane Co-Investment Fund III Holdings - 2 LP | 5% Or Greater Indirect Ownership Interest | Jul 1, 2018 | 6.68% |
| Deborah Stewart | Corporate Director | Jul 7, 2023 | |
| Bain Capital Fund XI LP | 5% Or Greater Indirect Ownership Interest | Jul 1, 2018 | 31.87% |
| Jerrold Perchik | Corporate Officer | Apr 29, 2024 | |
| Michelle Delaney | W-2 Managing Employee | Sep 1, 2024 | |
| Bcpe Eagle Investor, L.P. | 5% Or Greater Indirect Ownership Interest | Apr 29, 2021 | 37.52% |
| Jeffrey Shaner | Corporate Officer | Jul 1, 2018 | |
| Corporate Director | Jan 1, 2023 |
Facilities with the same owner 122
Facilities that share an organizational owner with 5% or greater ownership or operational control.
-
- Home Health Agency
- Stevenson Ranch, CA
- NPI 1093946238
Aveanna Healthcare Holdings Inc, Aveanna Healthcare Intermediate Holdings LLC, Aveanna Healthcare LLC, Bain Capital Fund XI LP, Bcpe Eagle Investor, L.P., Hamilton Lane Co-Investment Fund III Holdings - 2 LP, J.H. Whitney VII LP, Nut Tree Master Fu
-
- Home Health Agency
- West Covina, CA
- NPI 1104058122
Aveanna Healthcare Holdings Inc, Aveanna Healthcare Intermediate Holdings LLC, Aveanna Healthcare LLC, Bain Capital Fund XI LP, Bcpe Eagle Investor, L.P., Hamilton Lane Co-Investment Fund III Holdings - 2 LP, J.H. Whitney VII LP, Nut Tree Master Fu
-
- Home Health Agency
- Sherman Oaks, CA
- NPI 1114159381
Aveanna Healthcare Holdings Inc, Aveanna Healthcare Intermediate Holdings LLC, Aveanna Healthcare LLC, Bain Capital Fund XI LP, Bcpe Eagle Investor, L.P., Hamilton Lane Co-Investment Fund III Holdings - 2 LP, J.H. Whitney VII LP, Nut Tree Master Fu
-
- Home Health Agency
- San Jose, CA
- NPI 1114246816
Aveanna Healthcare Holdings Inc, Aveanna Healthcare Intermediate Holdings LLC, Aveanna Healthcare LLC, Bain Capital Fund XI LP, Bcpe Eagle Investor, L.P., Hamilton Lane Co-Investment Fund III Holdings - 2 LP, J.H. Whitney VII LP, Nut Tree Master Fu
-
- Home Health Agency
- Torrance, CA
- NPI 1134306970
Aveanna Healthcare Holdings Inc, Aveanna Healthcare Intermediate Holdings LLC, Aveanna Healthcare LLC, Bain Capital Fund XI LP, Bcpe Eagle Investor, L.P., Hamilton Lane Co-Investment Fund III Holdings - 2 LP, J.H. Whitney VII LP, Nut Tree Master Fu
-
- Home Health Agency
- Sacramento, CA
- NPI 1275764417
Aveanna Healthcare Holdings Inc, Aveanna Healthcare Intermediate Holdings LLC, Aveanna Healthcare LLC, Bain Capital Fund XI LP, Bcpe Eagle Investor, L.P., Hamilton Lane Co-Investment Fund III Holdings - 2 LP, J.H. Whitney VII LP, Nut Tree Master Fu
-
- Home Health Agency
- Orange, CA
- NPI 1326292897
Aveanna Healthcare Holdings Inc, Aveanna Healthcare Intermediate Holdings LLC, Aveanna Healthcare LLC, Bain Capital Fund XI LP, Bcpe Eagle Investor, L.P., Hamilton Lane Co-Investment Fund III Holdings - 2 LP, J.H. Whitney VII LP, Nut Tree Master Fu
-
- Home Health Agency
- Alameda, CA
- NPI 1396064093
Aveanna Healthcare Holdings Inc, Aveanna Healthcare Intermediate Holdings LLC, Aveanna Healthcare LLC, Bain Capital Fund XI LP, Hamilton Lane Co-Investment Fund III Holdings - 2 LP, J.H. Whitney VII LP, Psa Healthcare Investment Holding LLC
-
- Home Health Agency
- San Diego, CA
- NPI 1437385010
Aveanna Healthcare Holdings Inc, Aveanna Healthcare Intermediate Holdings LLC, Aveanna Healthcare LLC, Bain Capital Fund XI LP, Bcpe Eagle Investor, L.P., Hamilton Lane Co-Investment Fund III Holdings - 2 LP, J.H. Whitney VII LP, Nut Tree Master Fu
-
- Home Health Agency
- Culver City, CA
- NPI 1437400165
Aveanna Healthcare Holdings Inc, Aveanna Healthcare Intermediate Holdings LLC, Aveanna Healthcare LLC, Bain Capital Fund XI LP, Bcpe Eagle Investor, L.P., Hamilton Lane Co-Investment Fund III Holdings - 2 LP, J.H. Whitney VII LP, Nut Tree Master Fu
-
- Home Health Agency
- Temecula, CA
- NPI 1669600284
Aveanna Healthcare Holdings Inc, Aveanna Healthcare Intermediate Holdings LLC, Aveanna Healthcare LLC, Bain Capital Fund XI LP, Bcpe Eagle Investor, L.P., Hamilton Lane Co-Investment Fund III Holdings - 2 LP, J.H. Whitney VII LP, Nut Tree Master Fu
-
- Home Health Agency
- Palmdale, CA
- NPI 1811238967
Aveanna Healthcare Holdings Inc, Aveanna Healthcare Intermediate Holdings LLC, Aveanna Healthcare LLC, Bain Capital Fund XI LP, Bcpe Eagle Investor, L.P., Hamilton Lane Co-Investment Fund III Holdings - 2 LP, J.H. Whitney VII LP, Nut Tree Master Fu
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1391990400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1738022400000",
"number": "1295159366",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "400 INTERSTATE NORTH PKWY SE STE 1600",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303395047",
"telephone_number": "470-464-8000",
"fax_number": "770-248-8192"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12401 HESPERIA RD STE 8",
"city": "VICTORVILLE",
"state": "CA",
"postal_code": "923955844",
"telephone_number": "888-720-3826",
"fax_number": "888-712-3057"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PREMIER HEALTHCARE SERVICES, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2014-02-10",
"last_updated": "2025-01-28",
"certification_date": "2025-01-28",
"status": "A",
"authorized_official_last_name": "BUCKHALTER",
"authorized_official_first_name": "MATTHEW",
"authorized_official_title_or_position": "CFO",
"authorized_official_telephone_number": "470-464-8000"
},
"taxonomies": [
{
"code": "251E00000X",
"taxonomy_group": "",
"desc": "Home Health",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Aveanna Healthacare",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Victorville, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- 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.