PREMIER KIDS CARE, INC.

Provider Demographics

• NPI: 1326314733
• Name: PREMIER KIDS CARE, INC.
• Entity Type: Organization
• Organization Name: PREMIER KIDS CARE, INC.
• Other - Org Name: PREMIER CARE
• Other - Org Type: Doing Business As
• Authorized Official - Title/Position: PRESIDENT/CEO
• Authorized Official - First Name: JOY
• Authorized Official - Middle Name: A
• Authorized Official - Last Name: CHESNUT
• Authorized Official - Credentials: RN
• Authorized Official - Phone: 888-892-9001
• Mailing Address - Street 1: 221 PLAZA DR
• Mailing Address - City: MONROE
• Mailing Address - State: GA
• Mailing Address - Zip Code: 30655-3184
• Mailing Address - Country: US
• Mailing Address - Phone: 888-892-9001
• Mailing Address - Fax: 866-810-4012
• Practice Address - Street 1: 221 PLAZA DR
• Practice Address - City: MONROE
• Practice Address - State: GA
• Practice Address - Zip Code: 30655-3184
• Practice Address - Country: US
• Practice Address - Phone: 888-892-9001
• Practice Address - Fax: 866-810-4012
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2012-03-29
• Last Update Date: 2012-03-29

Provider Licenses

State	License ID	Taxonomies
GA	PHRE008225	3336C0003X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization
Yes	3336C0003X	Suppliers	Pharmacy	Community/Retail Pharmacy

Provider Identifiers

State	Identifier ID	ID Type	Issuer
GA	00712401B	Medicaid
NV	100505768	Medicaid
IA	1548237563	Medicaid
IN	200083690A	Medicaid
MD	4058372-00	Medicaid
VT	1548237563	Medicaid
OK	200047110A	Medicaid
OR	274567	Medicaid
AZ	919730	Medicaid
CT	003139004	Medicaid
TN	1548237563	Medicaid
KS	200434700A	Medicaid
MN	636645000	Medicaid
MT	1548237563	Medicaid
OH	2536947	Medicaid
WA	1548237563	Medicaid
KY	7100019090	Medicaid
SC	7G8225	Medicaid
PA	101129137-0002	Medicaid
WY	120590100	Medicaid
ID	807272000	Medicaid
MI	1548237563	Medicaid
NM	20385765	Medicaid
SC	7G8225	Medicaid
VT	1548237563	Medicaid