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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