Provider Demographics
NPI:1548932965
Name:ON TARGET PREMIER SERVICES LLC
Entity type:Organization
Organization Name:ON TARGET PREMIER SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIET
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON-RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:CASE MANAGER
Authorized Official - Phone:305-213-3703
Mailing Address - Street 1:7866 U.S. 701
Mailing Address - Street 2:29527
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29527
Mailing Address - Country:US
Mailing Address - Phone:305-213-3703
Mailing Address - Fax:
Practice Address - Street 1:1400 CHURCH ST
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-4104
Practice Address - Country:US
Practice Address - Phone:305-213-3703
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-04
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management