Premier Estates 520, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

PREMIER ESTATES 520, LLC

Practice address

4400 Vannest Ave
Middletown, OH 45042-2770

Phone

(513) 422-5600

NPI assigned

Oct 26, 2017

Last updated

Feb 1, 2019By 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

Cassidy Bancroft

Title

Chief Accounting Officer

Phone

(941) 758-4745

Specialties & licenses 2

Addresses

Other identifiers 2

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

{
    "created_epoch": "1508976000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1548979200000",
    "number": "1952813289",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4400 VANNEST AVE",
            "city": "MIDDLETOWN",
            "state": "OH",
            "postal_code": "450422770",
            "telephone_number": "513-422-5600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER ESTATES 520, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-10-26",
        "last_updated": "2019-02-01",
        "status": "A",
        "authorized_official_last_name": "BANCROFT",
        "authorized_official_first_name": "CASSIDY",
        "authorized_official_title_or_position": "CHIEF ACCOUNTING OFFICER",
        "authorized_official_telephone_number": "941-758-4745"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0250543",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0284516",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Zachary Porter
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• Premier Gastroenterology, Inc.
• Premier Health Specialists Inc (Middletown Pulmonary and Critical Care)
• Premier Health Specialists Inc (Premier Urology Center)
• Premier Health Specialists Inc (Advanced Cardiovascular Institute)
• Premier Health Specialists Inc (Premier Psychological Services)

• Skilled Nursing Facility in Middletown, OH
• Providers in Middletown, OH by specialty
• Skilled Nursing Facility in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2019; 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.