MEDICARE: PREMIER CARE COORDINATION

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	163WC0400X	Case Management Registered Nurse

General Provider Information

NPI Number	:	1487593539
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIER CARE COORDINATION

Provider Business Mailing Address
First Line	:	9105 E 56TH ST STE J
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46216-2231
Country	:	US
Telephone Number	:	317-751-1772
Fax Number	:

Provider Business Practice Location Address
First Line	:	219 N LAKE ST
Second Line	:
City	:	GARY
State	:	IN
Zip	:	46403-1964
Country	:	US
Telephone Number	:	317-751-1772
Fax Number	:

Authorized Official
Title or Position	:	OWNER AND FOUNDER
Name	:	RACHEL YATES
Credential	:
Telephone Number	:	317-751-1772

Provider Enumeration Date	:	03/25/2026
Last Update Date	:	03/25/2026

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