NPIMap

Organization Active NPI

Premier Healthcare Services, LLC

  • Home Health Agency
  • Corona, CA
National Provider Identifier
1942644596
Registry record updated Jan 28, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
PREMIER HEALTHCARE SERVICES, LLC
Practice address
200 S Main St
Suite 120
Corona, CA 92882-2211
Phone
(951) 735-4000
Fax
(877) 660-8410
NPI assigned
Apr 25, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 28, 2025

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)CodeLicenseStatePrimary
Home Health Agency 251E00000X CA Primary

Addresses

Primary practice location

200 S Main St
Suite 120
Corona, CA 92882-2211

Mailing address

400 Interstate North Pkwy SE Ste 1600
Atlanta, GA 30339-5047
Phone (470) 464-8000

Other names 1

  • Aveanna Healthcare Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130702000171 CA Part A Provider - Home Health Agency 2264517697 Practice locations: Corona, CA

Home health agency certification: CCN 059613

Legal name
PREMIER HEALTHCARE SERVICES, LLC
Doing business as
AVEANNA HEALTHCARE
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Apr 1, 2014
Last certification
Mar 31, 2021
Ownership / control type
Proprietary
Organization structure
LLCProprietary
Incorporated
Nov 7, 2005 in CA
Enrollment address
200 S Main St
Ste 120
Corona, CA 92882-2212

Other NPIs with the same Medicare PAC ID 15

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 15

Care Compare: Home health agency

Medicare Care Compare
Listed as
Aveanna HealthcareCCN 059613
Ownership
Proprietary
Certified
Apr 1, 2014
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D2065271Premier Healthcare Services, LLC200 S Main St, Ste 120, Corona, CA 92882Certificate of waiverSep 5, 2027

National Provider Directory

National Provider Directory
Tax ID family
Premier Healthcare Services24 organizations share this tax ID, including this one

Other organizations with this tax ID 23

Organizations that report the same tax identification number in the National Provider Directory.

View all 23

Locations

200 S Main St
Ste 120
Corona, CA 92882
Phone (951) 735-4000

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.

NameRoleSinceShare
J.H. Whitney VII LP Organization, New Canaan, CT For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Jul 1, 2018 6.18%
Psa Healthcare Investment Holding LLC Organization, New Canaan, CT Holding company, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Jul 1, 2018 7.14%
Aveanna Healthcare LLC Organization, Atlanta, GA LLC, For-profit, Chain home office, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Jul 1, 2018 100%
Aveanna Healthcare Intermediate Holdings LLC Organization, Atlanta, GA LLC, Holding company, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Jul 1, 2018 100%
Aveanna Healthcare Holdings Inc Organization, Atlanta, GA Corporation, Holding company, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Jul 1, 2018 100%
Nut Tree Master Fund LP Organization, New York, NY For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Dec 31, 2023 5.69%
Matthew Buckhalter Individual Corporate OfficerCfo Jul 7, 2023
Corporate DirectorCfo Jul 7, 2023
Hamilton Lane Co-Investment Fund III Holdings - 2 LP Organization, Bala Cynwyd, PA For-profit, Private equity company, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Jul 1, 2018 6.68%
Deborah Stewart Individual Corporate DirectorDirector Jul 7, 2023
Bain Capital Fund XI LP Organization, Boston, MA For-profit, Private equity company, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Jul 1, 2018 31.87%
Jerrold Perchik Individual Corporate OfficerSecretary Apr 29, 2024
Terin Glaser Individual W-2 Managing EmployeeAd; May 16, 2025
Bcpe Eagle Investor, L.P. Organization, Boston, MA Holding company, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Apr 29, 2021 37.52%
Jeffrey Shaner Individual Corporate OfficerCeo Jul 1, 2018
Corporate DirectorCeo Jan 1, 2023

Facilities with the same owner 122

Facilities that share an organizational owner with 5% or greater ownership or operational control.

  • Premier Healthcare Services, LLC
    • 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

    CMS ownership
  • Premier Healthcare Services, LLC
    • 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

    CMS ownership
  • Premier Healthcare Services, LLC
    • 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

    CMS ownership
  • Premier Healthcare Services, LLC
    • 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

    CMS ownership
  • Premier Healthcare Services, LLC
    • 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

    CMS ownership
  • Premier Healthcare Services, LLC
    • 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

    CMS ownership
  • Premier Healthcare Services, LLC
    • 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

    CMS ownership
  • Premier Healthcare Services, LLC
    • 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

    CMS ownership
  • Premier Healthcare Services, LLC
    • 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

    CMS ownership
  • Premier Healthcare Services, 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

    CMS ownership
  • Premier Healthcare Services, LLC
    • 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

    CMS ownership
  • Premier Healthcare Services, LLC
    • 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

    CMS ownership
View all 122

NPI Registry JSON

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

{
    "created_epoch": "1366848000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1738022400000",
    "number": "1942644596",
    "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": "200 S MAIN ST",
            "address_2": "SUITE 120",
            "city": "CORONA",
            "state": "CA",
            "postal_code": "928822211",
            "telephone_number": "951-735-4000",
            "fax_number": "877-660-8410"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER HEALTHCARE SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-04-25",
        "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": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Aveanna Healthcare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Corona, CA

Sources for this page

Verify at the official NPI Registry.