Premier Estates 505, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

840120 Issued in IA

Legal business name

PREMIER ESTATES 505, LLC

Practice address

309 Railroad St
Hull, IA 51239-7413

Phone

(712) 439-2758

Fax

(712) 439-2764

NPI assigned

Jan 11, 2016

Organization subpart

No

Name

Jamie Culp

Title

Controller

Phone

(941) 758-4745

Locations

• Pleasant Acres Care Center Doing business as

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jun 10, 2016.

{
    "created_epoch": "1452470400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1465516800000",
    "number": "1073979779",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5115 E STATE ROAD 64",
            "city": "BRADENTON",
            "state": "FL",
            "postal_code": "342085509",
            "telephone_number": "941-758-4745",
            "fax_number": "941-751-2135"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "309 RAILROAD ST",
            "city": "HULL",
            "state": "IA",
            "postal_code": "512397413",
            "telephone_number": "712-439-2758",
            "fax_number": "712-439-2764"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER ESTATES 505, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-01-11",
        "last_updated": "2016-06-10",
        "status": "A",
        "authorized_official_last_name": "CULP",
        "authorized_official_first_name": "JAMIE",
        "authorized_official_title_or_position": "CONTROLLER",
        "authorized_official_telephone_number": "941-758-4745"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "IA",
            "license": "840120",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0800182",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pleasant Acres Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Tarah Kooima, DPT
• Morning Glory Birth & Wellness
• Opco Hull, Ia, LLC
• Pleasant Acres Care Center, Inc.
• Erika Elizabeth Pottebaum
• Scott Rens, MD
• Sanford Health Network
• Sioux Center Health
• Leah Ann Vande Hoef
• Dana Elaine Visser

• All providers in Hull, IA
• Skilled Nursing Facility in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2016; 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.