=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285594200
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PREMIER KIDS ACADEMY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/12/2025
-----------------------------------------------------
Last Update Date | 11/12/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5171 MAYFIELD RD
-----------------------------------------------------
City | LYNDHURST
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44124-2405
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-209-2296
-----------------------------------------------------
Fax | 440-683-4227
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5171 MAYFIELD RD
-----------------------------------------------------
City | LYNDHURST
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44124-2405
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-209-2296
-----------------------------------------------------
Fax | 440-683-4227
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | TANISHA JAMISON
-----------------------------------------------------
Credential | CEO,AA
-----------------------------------------------------
Telephone | 440-488-7341
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 385HR2050X
-----------------------------------------------------
Taxonomy Name | Respite Care Camp
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 385HR2055X
-----------------------------------------------------
Taxonomy Name | Child Mental Illness Respite Care
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 385HR2065X
-----------------------------------------------------
Taxonomy Name | Child Physical Disabilities Respite Care
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 385HR2060X
-----------------------------------------------------
Taxonomy Name | Child Intellectual and/or Developmental Disabilities Respite Care
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------