Premier Providers Inc Dba Bradner Village Health Care Center

Primary specialty

Nursing Facility/Intermediate Care FacilityTaxonomy code 313M00000X

Legal business name

PREMIER PROVIDERS INC DBA BRADNER VILLAGE HEALTH CARE CENTER

Practice address

505 N Bradner Ave
Marion, IN 46952-2449

Phone

(765) 662-3981

Fax

(765) 662-3981

NPI assigned

Jul 1, 2005

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Eric Walts, MBA

Title

Ceo

Phone

(765) 662-3981

Specialties & licenses 1

Addresses

Other names 1

• Bradner Village Health Care Center Other name

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

{
    "created_epoch": "1120176000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1124025457",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "505 N BRADNER AVE",
            "city": "MARION",
            "state": "IN",
            "postal_code": "469522449",
            "telephone_number": "765-662-3981",
            "fax_number": "765-662-3981"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "505 N BRADNER AVE",
            "city": "MARION",
            "state": "IN",
            "postal_code": "469522449",
            "telephone_number": "765-662-3981",
            "fax_number": "765-662-3981"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER PROVIDERS INC DBA BRADNER VILLAGE HEALTH CARE CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-01",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WALTS",
        "authorized_official_first_name": "ERIC",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "765-662-3981",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MBA"
    },
    "taxonomies": [
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "IN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bradner Village Health Care Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.