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Organization
PREMIER ESTATES 504, LLC
Active
Organization
PREMIER ESTATES 504, LLC
Active
Other names
Grundy Care Center
Organization subpart
No
Provider details
NPI number
Authorized official
JAMIE CULP (CONTROLLER)
(941) 758-4745
Entity
Organization
Contact information
Practice address
102 E J AVE, GRUNDY CENTER, IA 50638-2031
(319) 824-5436
(319) 824-5808
Mailing address
5115 E STATE ROAD 64, BRADENTON, FL 34208-5509
(941) 758-4745
(941) 751-2135
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
380377
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0800181
—
IA
Enumeration date
01/11/2016
Last updated
06/10/2016
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