Premier Operating Countryside Village, LLC

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

Legal business name

PREMIER OPERATING COUNTRYSIDE VILLAGE, LLC

Practice address

5383 US Highway 117 N
Pikeville, NC 27863-9443

Phone

(919) 242-6369

Fax

(919) 242-9884

NPI assigned

May 10, 2016

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

Robert Borsody

Title

Principal

Phone

(212) 739-0794

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1462838400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1462838400000",
    "number": "1467808329",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5383 US HIGHWAY 117 N",
            "city": "PIKEVILLE",
            "state": "NC",
            "postal_code": "278639443",
            "telephone_number": "919-242-6369",
            "fax_number": "919-242-9884"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5383 US HIGHWAY 117 N",
            "city": "PIKEVILLE",
            "state": "NC",
            "postal_code": "278639443",
            "telephone_number": "919-242-6369",
            "fax_number": "919-242-9884"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER OPERATING COUNTRYSIDE VILLAGE, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PREMIER SENIOR LIVING, LLC",
        "enumeration_date": "2016-05-10",
        "last_updated": "2016-05-10",
        "status": "A",
        "authorized_official_last_name": "BORSODY",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "PRINCIPAL",
        "authorized_official_telephone_number": "212-739-0794"
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "NC",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Providers in Pikeville, NC by specialty
• Adult Care Home Facility in North Carolina

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