Active NPI
Premier Healthcare Services, LLC
- Home Health Agency
- San Diego, CA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Home Health Agency
- License
- 550001308
- Legal business name
- PREMIER HEALTHCARE SERVICES, LLC
- Practice address
- 2020 Camino del Rio N
Suite 600
San Diego, CA 92108-1541 - Phone
- (619) 574-6744
- Fax
- (877) 501-0396
- NPI assigned
- Jun 9, 2009
- 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 | 550001308 | CA | Primary |
Addresses
Primary practice location
2020 Camino del Rio N
Suite 600
San Diego, CA 92108-1541
Mailing address
400 Interstate North Pkwy SE Ste 1600
Atlanta, GA 30339-5047
Phone (470) 464-8000
Other names 1
- Aveanna Healthcare
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20110921000749 | CA | Part A Provider - Home Health Agency | 2264517697 | Practice locations: San Diego, CA |
Home health agency certification: CCN 059296
- Legal name
- PREMIER HEALTHCARE SERVICES, LLC
- Doing business as
- AVEANNA HEALTHCARE
- Certification status
- Active
- Provider type (POS)
- Home health agency
- Participating since
- Apr 13, 2011
- Last certification
- Jan 25, 2017
- Ownership / control type
- Government Operated
- Organization structure
- LLC
- Incorporated
- Nov 7, 2005 in CA
- Enrollment address
- 2020 Camino del Rio N
Ste 600
San Diego, CA 92108-1545
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
- Government Operated
- Certified
- Apr 13, 2011
- 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 |
|---|---|---|---|
| 05D1097033 | Premier Healthcare Services, LLC | Certificate of waiver | Mar 16, 2027 |
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
- Victorville, CA
- NPI 1295159366
-
- Home Health Agency
- Orange, CA
- NPI 1326292897
-
- Home Health Agency
- Alameda, CA
- NPI 1396064093
-
- Home Health Agency
- Bakersfield, CA
- NPI 1407280563
-
- Home Health Agency
- Culver City, CA
- NPI 1437400165
Locations
2020 Camino del Rio N
Ste 600
San Diego, CA 92108
Phone (619) 265-1234
Ownership & related parties
All disclosed owners & managing parties 16
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 | 16.09% |
| Psa Healthcare Investment Holding LLC | 5% Or Greater Indirect Ownership Interest | Jul 1, 2018 | 8.04% |
| 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 | 6.34% |
| Matthew Buckhalter | Corporate Officer | Jul 7, 2023 | |
| Corporate Director | Jul 7, 2023 | ||
| Bcip Associates IV US L.P. | 5% Or Greater Indirect Ownership Interest | Jul 1, 2018 | 5.35% |
| Hamilton Lane Co-Investment Fund III Holdings - 2 LP | 5% Or Greater Indirect Ownership Interest | Jul 1, 2018 | 7.5% |
| Maureen Capuno | W-2 Managing Employee | Jan 23, 2022 | |
| Deborah Stewart | Corporate Director | Jul 7, 2023 | |
| Bain Capital Fund XI LP | 5% Or Greater Indirect Ownership Interest | Jul 1, 2018 | 35.54% |
| Jerrold Perchik | Corporate Officer | Apr 29, 2024 | |
| Bcpe Eagle Investor, L.P. | 5% Or Greater Indirect Ownership Interest | Apr 29, 2021 | 41.83% |
| Jeffrey Shaner | Corporate Officer | Jul 1, 2018 | |
| Corporate Director | Jan 1, 2023 | ||
| Pea Washington Holdings, LP | 5% Or Greater Indirect Ownership Interest | Apr 29, 2021 | 5.45% |
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, Bcip Associates IV US L.P., Bcpe Eagle Investor, L.P., Hamilton Lane Co-Investment Fund III Holdings - 2 LP, J.H. Whitne
-
- 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, Bcip Associates IV US L.P., Bcpe Eagle Investor, L.P., Hamilton Lane Co-Investment Fund III Holdings - 2 LP, J.H. Whitne
-
- 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, Bcip Associates IV US L.P., Bcpe Eagle Investor, L.P., Hamilton Lane Co-Investment Fund III Holdings - 2 LP, J.H. Whitne
-
- 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, Bcip Associates IV US L.P., Bcpe Eagle Investor, L.P., Hamilton Lane Co-Investment Fund III Holdings - 2 LP, J.H. Whitne
-
- Home Health Agency
- Victorville, CA
- NPI 1295159366
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, Bcip Associates IV US L.P., Hamilton Lane Co-Investment Fund III Holdings - 2 LP, J.H. Whitney VII LP, Psa Healthcare in
-
- 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, Bcip Associates IV US L.P., Bcpe Eagle Investor, L.P., Hamilton Lane Co-Investment Fund III Holdings - 2 LP, J.H. Whitne
-
- Home Health Agency
- Temecula, CA
- NPI 1669600284
Aveanna Healthcare Holdings Inc, Aveanna Healthcare Intermediate Holdings LLC, Aveanna Healthcare LLC, Bain Capital Fund XI LP, Bcip Associates IV US L.P., Bcpe Eagle Investor, L.P., Hamilton Lane Co-Investment Fund III Holdings - 2 LP, J.H. Whitne
-
- 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": "1244505600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1738022400000",
"number": "1437385010",
"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": "2020 CAMINO DEL RIO N",
"address_2": "SUITE 600",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921081541",
"telephone_number": "619-574-6744",
"fax_number": "877-501-0396"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PREMIER HEALTHCARE SERVICES, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2009-06-09",
"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": "CA",
"license": "550001308",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Aveanna Healthcare",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in San Diego, 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.