Premium Direct Care Providers Inc.

Primary specialty

Developmental Disabilities Clinic/CenterTaxonomy code 261QD1600X

Legal business name

PREMIUM DIRECT CARE PROVIDERS INC.

Practice address

1612 Bonforte Blvd
Pueblo, CO 81001-1603

Phone

(719) 543-3600

NPI assigned

Dec 7, 2015

Organization subpart

No

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

Authorized official

Name

Joann Madrid

Title

President

Phone

(719) 543-3600

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1449446400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1449446400000",
    "number": "1346615085",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1612 BONFORTE BLVD",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810011603"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1612 BONFORTE BLVD",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810011603",
            "telephone_number": "719-543-3600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIUM DIRECT CARE PROVIDERS INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-12-07",
        "last_updated": "2015-12-07",
        "status": "A",
        "authorized_official_last_name": "MADRID",
        "authorized_official_first_name": "JOANN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "719-543-3600"
    },
    "taxonomies": [
        {
            "code": "261QD1600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Praxair Healthcare Services, Inc.
• Noah Palmer Prebish
• Danielle Predovich, RN
• Premier Back Rehabilitation Center, PC
• Premier Home Health, Inc
• Prescription Shop LLC
• Prescription Shop LLC
• Blair Christian Presti, MD
• Prestige Dental Pueblo, PLLC
• Prestige Denture Clinic

• Developmental Disabilities Clinic/Center in Pueblo, CO
• Providers in Pueblo, CO by specialty
• Developmental Disabilities Clinic/Center in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.