MEDICARE: PREMIER KIDS HOME CARE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1093569451
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIER KIDS HOME CARE, LLC

Provider Business Mailing Address
First Line	:	1301 S BOWEN RD STE 140
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76013-2301
Country	:	US
Telephone Number	:	469-654-1245
Fax Number	:	469-485-7312

Provider Business Practice Location Address
First Line	:	1301 S BOWEN RD STE 140
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76013-2301
Country	:	US
Telephone Number	:	469-654-1245
Fax Number	:	469-485-7312

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. MARCO ANTONIO HERNANDEZ
Credential	:
Telephone Number	:	817-919-5929

Provider Enumeration Date	:	04/12/2024
Last Update Date	:	04/12/2024

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