Organization
PREMIER ESTATES OF DUBLIN LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GREGORY SHAYNE BENCH (CFO)
(941) 758-4745
Entity
Organization
Contact information
Practice address
1634 TELFAIR ST, DUBLIN, GA 31021-3115
(478) 272-1133
(478) 272-4401
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
—
000141281A
—
GA
Enumeration date
05/01/2015
Last updated
12/23/2015
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