Healthcare Provider Details

I. General information

NPI: 1487593539
Provider Name (Legal Business Name): PREMIER CARE COORDINATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2026
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 N LAKE ST
GARY IN
46403-1964
US

IV. Provider business mailing address

9105 E 56TH ST STE J
INDIANAPOLIS IN
46216-2231
US

V. Phone/Fax

Practice location:
  • Phone: 317-751-1772
  • Fax:
Mailing address:
  • Phone: 317-751-1772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: RACHEL YATES
Title or Position: OWNER AND FOUNDER
Credential:
Phone: 317-751-1772