Healthcare Provider Details

I. General information

NPI: 1336595255
Provider Name (Legal Business Name): PREMIER OPERATING CROATAN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2016
Last Update Date: 05/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4522 OLD CHERRY POINT RD
NEW BERN NC
28560-8012
US

IV. Provider business mailing address

4522 OLD CHERRY POINT RD
NEW BERN NC
28560-8012
US

V. Phone/Fax

Practice location:
  • Phone: 252-634-9066
  • Fax: 252-634-1862
Mailing address:
  • Phone: 252-634-9066
  • Fax: 252-634-1862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number StateNC

VIII. Authorized Official

Name: ROBERT BORSODY
Title or Position: PRINCIPAL
Credential:
Phone: 212-739-0794