Healthcare Provider Details

I. General information

NPI: 1952813289
Provider Name (Legal Business Name): PREMIER ESTATES 520, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2017
Last Update Date: 02/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 VANNEST AVE
MIDDLETOWN OH
45042-2770
US

IV. Provider business mailing address

5115 E STATE ROAD 64
BRADENTON FL
34208-5509
US

V. Phone/Fax

Practice location:
  • Phone: 513-422-5600
  • Fax:
Mailing address:
  • Phone: 941-758-4745
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: CASSIDY BANCROFT
Title or Position: CHIEF ACCOUNTING OFFICER
Credential:
Phone: 941-758-4745