Provider Demographics
NPI:1548237563
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:CONTRACTS AND LICENSURE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEICHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-207-9001
Mailing Address - Street 1:221 PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:GA
Mailing Address - Zip Code:30655-3184
Mailing Address - Country:US
Mailing Address - Phone:770-207-9001
Mailing Address - Fax:770-207-8987
Practice Address - Street 1:221 PLAZA DR
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:GA
Practice Address - Zip Code:30655-3184
Practice Address - Country:US
Practice Address - Phone:770-207-9001
Practice Address - Fax:770-207-8987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-08
Last Update Date:2012-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE008225332B00000X, 3336C0003X, 3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1145324OtherNABP #
GA00712401BMedicaid
GA1145324OtherNABP #