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Organization

PREMIER ESTATES 506, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
CASSIDY BANCROFT (CONTROLLER)
(941) 758-4745
Entity
Organization

Contact information

Practice address
3661 ROCHESTER AVE, IOWA CITY, IA 52245-9271
(319) 351-7460
(319) 354-8428
Mailing address
5115 E STATE ROAD 64, BRADENTON, FL 34208-5509
(941) 758-4745
(941) 751-2135

Taxonomy

Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
520052
IA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0800179
IA
Enumeration date
01/11/2016
Last updated
01/09/2018
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