Organization
PREMIER ESTATES OF KENESAW, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GREGORY BENCH (CFO)
(941) 758-4745
Entity
Organization
Contact information
Practice address
100 W ELM ST, KENESAW, NE 68956-1543
(402) 752-3212
(402) 752-8128
Mailing address
5265 OFFICE PARK BLVD, BRADENTON, FL 34203-3441
(941) 758-4745
(941) 751-2135
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100265079-00
—
NE
Enumeration date
04/30/2015
Last updated
10/14/2015
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