1326314733 NPI number — PREMIER KIDS CARE, INC.

Table of content: (NPI 1326314733)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326314733 NPI number — PREMIER KIDS CARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PREMIER KIDS CARE, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326314733
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/29/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
221 PLAZA DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONROE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30655-3184
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-892-9001
Provider Business Mailing Address Fax Number:
866-810-4012

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
221 PLAZA DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONROE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30655-3184
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-892-9001
Provider Business Practice Location Address Fax Number:
866-810-4012
Provider Enumeration Date:
03/29/2012

Additional Information

Authorized Official

Authorized Official Last Name:
CHESNUT
Authorized Official First Name:
JOY
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
888-892-9001

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  PHRE008225 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00712401B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100505768 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1548237563 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200083690A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4058372-00 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1548237563 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200047110A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 274567 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 919730 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 003139004 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1548237563 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200434700A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 636645000 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1548237563 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2536947 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1548237563 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100019090 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7G8225 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 101129137-0002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 120590100 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".




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