Premier Estates of Fremont, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

PREMIER ESTATES OF FREMONT, LLC

Practice address

2550 N Nye Ave
Fremont, NE 68025-2242

Phone

(402) 727-1701

Fax

(402) 727-1619

NPI assigned

Apr 30, 2015

Organization subpart

No

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

Authorized official

Name

Gregory Shayne Bench

Title

Cfo

Phone

(941) 758-4745

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1430352000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1444435200000",
    "number": "1538546379",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5265 OFFICE PARK BLVD",
            "address_2": "SUITE 101",
            "city": "BRADENTON",
            "state": "FL",
            "postal_code": "342033441",
            "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": "2550 N NYE AVE",
            "city": "FREMONT",
            "state": "NE",
            "postal_code": "680252242",
            "telephone_number": "402-727-1701",
            "fax_number": "402-727-1619"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER ESTATES OF FREMONT, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-30",
        "last_updated": "2015-10-10",
        "status": "A",
        "authorized_official_last_name": "BENCH",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_middle_name": "SHAYNE",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "941-758-4745"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100265078-00",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Cassandra J Potter
• Melissa Powell
• Tandie J Powell, M.S.,CCC-SLP
• Prairie Fields Family Medicine, P.C.
• Premere Rehab LLC
• Sarah Preston, LICSW, LIMHP, LADC
• Samantha Prichard, PA
• Priscilla Wilson, LMHP, NCC
• Professional Hearing Center, PC
• Professional Hearing Ctr PC

• Skilled Nursing Facility in Fremont, NE
• Providers in Fremont, NE by specialty
• Skilled Nursing Facility in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2015; 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.