Organization
PREMIER ESTATES 520, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CASSIDY BANCROFT (CHIEF ACCOUNTING OFFICER)
(941) 758-4745
Entity
Organization
Contact information
Practice address
4400 VANNEST AVE, MIDDLETOWN, OH 45042-2770
(513) 422-5600
Mailing address
5115 E STATE ROAD 64, BRADENTON, FL 34208-5509
(941) 758-4745
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
—
—
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0250543
—
OH
05
—
0284516
—
OH
Enumeration date
10/26/2017
Last updated
02/01/2019
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