NPIMap

Organization Active NPI

Premier Health Care Services, LLC

  • Home Health Agency
  • St Thomas, VI
National Provider Identifier
1386949980
Registry record updated May 2, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
1-2085-1L Issued in VI
Legal business name
PREMIER HEALTH CARE SERVICES, LLC
Practice address
3-4 Estate Thomas
St. Thomas, VI 00802
Phone
(340) 774-7427
Fax
(340) 774-7430
NPI assigned
Jan 13, 2011
Last updated
May 2, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 2, 2021

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

Authorized official

Name
Mrs. Joycelyn Petersen, RN
Title
Administrator
Phone
(229) 630-4427

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X 1-2085-1L VI Primary

Addresses

Primary practice location

3-4 Estate Thomas
St. Thomas, VI 00802

Mailing address

PO Box 9052
St Thomas, VI 00801-2052
Phone (340) 774-7427

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120124000973 VI Part A Provider - Home Health Agency 7517134018 Practice locations: St Thomas, VI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1386949980. Details of each certification follow.

Home health agency certification: CCN 487003

Legal name
PREMIER HEALTH CARE SERVICES, LLC
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Feb 15, 2013
Last certification
Mar 15, 2019
Ownership / control type
Proprietary
Organization structure
LLCProprietary
Incorporated
Oct 1, 2010 in VI
Enrollment address
3 4 Estate Thomas
St Thomas, VI 00802

Care Compare: Home health agency

Medicare Care Compare
Listed as
Premier Health Care ServicesCCN 487003 · All quality measures
Overall star rating
4 of 5
Ownership
Proprietary
Certified
Feb 15, 2013
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical therapy

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 6

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Joycelyn Petersen Individual 5% Or Greater Direct Ownership Interest Jun 5, 2011 60%
Corporate OfficerPresident/ Ceo Feb 5, 2011
W-2 Managing EmployeeAdministrator Jul 1, 2011
Stephanie Richards Individual 5% Or Greater Direct Ownership Interest Jun 5, 2011 10.03%
Corporate OfficerSecretary/ Treasurer Feb 5, 2011
Clarence Clarke Individual 5% Or Greater Direct Ownership Interest Jun 5, 2011 9.99%
Tamara Petersen Individual W-2 Managing EmployeeBusiness Office Manager Aug 25, 2021
Other Jun 5, 2011
Beverly Clarke Individual 5% Or Greater Direct Ownership Interest Jun 5, 2011 9.99%
Elma Sanjurjo-Brunson Individual 5% Or Greater Direct Ownership Interest Jun 5, 2011 9.99%

Practitioners & affiliated clinicians

Affiliated clinicians 9

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1294876800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1619913600000",
    "number": "1386949980",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9052",
            "city": "ST THOMAS",
            "state": "VI",
            "postal_code": "008012052",
            "telephone_number": "340-774-7427",
            "fax_number": "340-774-7430"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3-4 ESTATE THOMAS",
            "city": "ST. THOMAS",
            "state": "VI",
            "postal_code": "00802",
            "telephone_number": "340-774-7427",
            "fax_number": "340-774-7430"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER HEALTH CARE SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-13",
        "last_updated": "2021-05-02",
        "certification_date": "2021-05-02",
        "status": "A",
        "authorized_official_last_name": "PETERSEN",
        "authorized_official_first_name": "JOYCELYN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "229-630-4427",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "VI",
            "license": "1-2085-1L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in St Thomas, VI

Sources for this page

Verify at the official NPI Registry.