Provider Demographics
NPI:1689806796
Name:PREMIER ACADEMY OHIO
Entity Type:Organization
Organization Name:PREMIER ACADEMY OHIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:XAVIER
Authorized Official - Last Name:HUELSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-578-7796
Mailing Address - Street 1:1555 ELAINE RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43227-2347
Mailing Address - Country:US
Mailing Address - Phone:614-501-3820
Mailing Address - Fax:614-501-3822
Practice Address - Street 1:1555 ELAINE RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43227-2347
Practice Address - Country:US
Practice Address - Phone:614-501-3820
Practice Address - Fax:614-501-3822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-23
Last Update Date:2009-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH000938251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH=========OtherIRN