Premier Operating Fountain Park, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

PREMIER OPERATING FOUNTAIN PARK, LLC

Practice address

1391 N Main St
Bryan, OH 43506-1057

Phone

(419) 633-9191

Fax

(419) 633-9192

NPI assigned

Jun 16, 2025

Organization subpart

Yes

Parent organization

PREMIER SENIOR LIVING, LLCAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Wayne Kaplan

Title

Owner

Phone

(516) 359-1066

Specialties & licenses 1

Addresses

Other names 1

• Reisen Center Other name

Tax ID family

Inn at Fountain Park2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Premier Operating Fountain Park, LLC

  • Assisted Living Facility
  • Bryan, OH
  • NPI 1992691182
  NPD tax ID

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1750032000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1779753600000",
    "number": "1073409165",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1391 N MAIN ST",
            "city": "BRYAN",
            "state": "OH",
            "postal_code": "435061057",
            "telephone_number": "419-633-9191",
            "fax_number": "419-633-9192"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1391 N MAIN ST",
            "city": "BRYAN",
            "state": "OH",
            "postal_code": "435061057",
            "telephone_number": "419-633-9191",
            "fax_number": "419-633-9192"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER OPERATING FOUNTAIN PARK, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PREMIER SENIOR LIVING, LLC",
        "enumeration_date": "2025-06-16",
        "last_updated": "2026-05-26",
        "certification_date": "2026-05-26",
        "status": "A",
        "authorized_official_last_name": "KAPLAN",
        "authorized_official_first_name": "WAYNE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "516-359-1066"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Reisen Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Tiffany Rae Poletta, COTA/L
• Brianna Rae Pool, A-GNP
• Sara Porter
• Nicole Marie Pothast, MSN, CNM
• Rebecca Ann Powers, COTA/L
• Premier Operating Fountain Park, LLC
• Premier Operating Ohio, LLC
• Premier Operating Ohio, LLC
• Pro Rad, Inc
• Sharon A. Ransom, MD

• All providers in Bryan, OH
• Assisted Living Facility in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.