Provider Demographics
NPI:1679594782
Name:PREMIER CARE AND LEARNING CENTER, INC
Entity type:Organization
Organization Name:PREMIER CARE AND LEARNING CENTER, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:FLORINE
Authorized Official - Middle Name:
Authorized Official - Last Name:KESSEE-DOYLE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:318-635-5900
Mailing Address - Street 1:2110 HOLLYWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71108-3922
Mailing Address - Country:US
Mailing Address - Phone:318-635-5900
Mailing Address - Fax:318-635-5601
Practice Address - Street 1:2110 HOLLYWOOD AVE
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71108-3922
Practice Address - Country:US
Practice Address - Phone:318-635-5900
Practice Address - Fax:318-635-5601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1443760Medicaid
LA5CE65Medicare ID - Type Unspecified