Organization
PREMIER ESTATES 510, LLC
Active
Other names
Casa De Paz Health Care Center
Organization subpart
No
Provider details
NPI number
Authorized official
JAMIE CULP (CONTROLLER)
(941) 758-4745
Entity
Organization
Contact information
Practice address
2121 W 19TH ST, SIOUX CITY, IA 51103-2333
(712) 233-3127
(712) 258-1117
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
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0800176
—
IA
Enumeration date
01/11/2016
Last updated
05/13/2016
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