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NPI Code Detail

MEDICARE: PREMIER ESTATES OF PIERCE, LLC

MEDICARE: PREMIER ESTATES OF PIERCE, LLC
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
1314000000XSkilled Nursing Facility

Other Identifiers

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

General Provider Information

NPI Number : 1205213055
Entity Type Code : Organization
Provider Name (Legal Business Name) : PREMIER ESTATES OF PIERCE, LLC
Provider Business Mailing Address
First Line : 5265 OFFICE PARK BLVD
Second Line :
City : BRADENTON
State : FL
Zip : 34203-3441
Country : US
Telephone Number : 941-758-4745
Fax Number : 941-751-2135
Provider Business Practice Location Address
First Line : 515 E MAIN ST
Second Line :
City : PIERCE
State : NE
Zip : 68767-1660
Country : US
Telephone Number : 402-329-6228
Fax Number : 402-329-4188
Authorized Official
Title or Position : CFO
Name : GREGORY BENCH
Credential :
Telephone Number : 941-758-4745
Provider Enumeration Date : 04/30/2015
Last Update Date : 10/14/2015

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Directions to “PREMIER ESTATES OF PIERCE, LLC ” Practice Location

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