Premier Estates 509, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

730056 Issued in IA

Legal business name

PREMIER ESTATES 509, LLC

Practice address

1200 W Nishna Rd
Shenandoah, IA 51601-2116

Phone

(712) 246-4515

Fax

(712) 246-5085

NPI assigned

Jan 11, 2016

Organization subpart

No

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

Authorized official

Name

Jamie Culp

Title

Controller

Phone

(941) 758-4745

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Garden View Care Center Doing business as

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

{
    "created_epoch": "1452470400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1463097600000",
    "number": "1184080889",
    "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": "1200 W NISHNA RD",
            "city": "SHENANDOAH",
            "state": "IA",
            "postal_code": "516012116",
            "telephone_number": "712-246-4515",
            "fax_number": "712-246-5085"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER ESTATES 509, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-01-11",
        "last_updated": "2016-05-13",
        "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": "730056",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0800174",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Garden View Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• John P Outhier, DC
• Page County
• Joyce Portz Ann Portz, RN
• Matthew Paul Potratz, D.C.
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• Premier Healthcare of Shenandoah, P.C.
• Premier Host Homes, LLC
• Premier Waiver Homes LLC
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• Renal Treatment Centers-Illinois Inc

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 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.