MEDICARE: PREMIER CARE AND LEARNING CENTER, INC

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	261Q00000X	Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679594782
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIER CARE AND LEARNING CENTER, INC

Provider Business Mailing Address
First Line	:	2110 HOLLYWOOD AVE
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71108-3922
Country	:	US
Telephone Number	:	318-635-5900
Fax Number	:	318-635-5601

Provider Business Practice Location Address
First Line	:	2110 HOLLYWOOD AVE
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71108-3922
Country	:	US
Telephone Number	:	318-635-5900
Fax Number	:	318-635-5601

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MS. FLORINE KESSEE-DOYLE
Credential	:	RN
Telephone Number	:	318-635-5900

Provider Enumeration Date	:	07/22/2006
Last Update Date	:	08/22/2020

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