Healthcare Provider Details

I. General information

NPI: 1831601160
Provider Name (Legal Business Name): PREMIER ESTATES 523, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2017
Last Update Date: 02/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6099 FAIRFIELD RD
OXFORD OH
45056-1507
US

IV. Provider business mailing address

5115 E STATE ROAD 64
BRADENTON FL
34208-5509
US

V. Phone/Fax

Practice location:
  • Phone: 513-523-6353
  • Fax:
Mailing address:
  • Phone: 941-758-4745
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: ADRIANNA BANCROFT
Title or Position: RECEPTIONIST
Credential:
Phone: 941-758-4745