Provider Demographics
NPI:1902842545
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 - Prefix:
Authorized Official - First Name:JOY
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCMILLAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:888-892-9001
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:888-892-9001
Mailing Address - Fax:866-810-4021
Practice Address - Street 1:601 N 21ST AVE
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-4049
Practice Address - Country:US
Practice Address - Phone:888-892-9001
Practice Address - Fax:866-810-4021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336S0011X
FLPH216673336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL031166900Medicaid
2005691OtherPK
FL031166900Medicaid