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General NPI Number Information
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NPI Number | 1336595255
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Entity Type | Organization
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Legal Business Name | PREMIER OPERATING CROATAN, LLC
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Dates
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Enumeration Date | 05/10/2016
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Last Update Date | 05/10/2016
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Provider Practice Location Address
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Address Line | 4522 OLD CHERRY POINT RD
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City | NEW BERN
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State | NC
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Zip | 28560-8012
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Country | US
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Telephone | 252-634-9066
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Fax | 252-634-1862
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Provider Business Mailing Address
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Address Line | 4522 OLD CHERRY POINT RD
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City | NEW BERN
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State | NC
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Zip | 28560-8012
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Country | US
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Telephone | 252-634-9066
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Fax | 252-634-1862
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Authorized Official
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Title or Position | PRINCIPAL
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Name | ROBERT BORSODY
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Credential |
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Telephone | 212-739-0794
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State | NC
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