| Organization Name: | PREMIER LIFE WELLNESS LLC |
| NPI Number: | 1952571234 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | LORAINE M GUMPER (OWNER) |
| Mailing Address: | 1625 Addison Ave E Twin Falls |
| State: | ID US |
| Postal Code: | 833015343 |
| Phone Number: | 2087352442 |
| Fax Number: | 2087359030 |
| NPI Enumeration Date: | 03/03/2008 |
| NPI Last Update Date: | 03/03/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 302R00000X |
| License Number: | CHIA-754 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ID |
| Taxonomy Type: | Managed Care Organizations |
| Taxonomy Classification: | Health Maintenance Organization |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) A form of health insurance in which its members prepay a premium for the HMO |