Premier Plus Community Living LLC

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

Legal business name

PREMIER PLUS COMMUNITY LIVING LLC

Practice address

4008 Genesee PL Ste 105
Woodbridge, VA 22192-8306

Phone

(703) 455-3385

Fax

(703) 580-9308

NPI assigned

May 18, 2023

Organization subpart

No

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

Authorized official

Name

Mr. Prince Afari Boateng

Title

Administrator

Phone

(703) 455-3385

Specialties & licenses 1

Addresses

Other names 1

• Premier Plus Community Living LLC Doing business as

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

{
    "created_epoch": "1684368000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1685750400000",
    "number": "1629769682",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4008 GENESEE PL STE 105",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221928306",
            "telephone_number": "703-455-3385",
            "fax_number": "703-580-9308"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4008 GENESEE PL STE 105",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221928306",
            "telephone_number": "703-455-3385",
            "fax_number": "703-580-9308"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER PLUS COMMUNITY LIVING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-05-18",
        "last_updated": "2023-06-03",
        "certification_date": "2023-06-03",
        "status": "A",
        "authorized_official_last_name": "BOATENG",
        "authorized_official_first_name": "PRINCE",
        "authorized_official_middle_name": "AFARI",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "703-455-3385",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Premier Plus Community Living LLC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Premier Plus Community Living LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Adult Care Home Facility in Woodbridge, VA
• Providers in Woodbridge, VA by specialty
• Adult Care Home Facility in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2023; 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.