Premier Operating Fountain Park, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

PREMIER OPERATING FOUNTAIN PARK, LLC

Practice address

1433 N Main St
Bryan, OH 43506-1053

Phone

(419) 633-9191

Fax

(419) 633-3082

NPI assigned

Jun 16, 2025

Last updated

May 26, 2026By the provider in NPPES

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

Mr. Wayne Kaplan

Title

Owner

Phone

(516) 359-1066

Specialties & licenses 1

Addresses

Other names 1

• Inn at Fountain Park Other name

Tax ID family

Inn at Fountain Park2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Premier Operating Fountain Park, LLC

  • Assisted Living Facility
  • Bryan, OH
  • NPI 1073409165
  NPD tax ID

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

{
    "created_epoch": "1750032000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1779753600000",
    "number": "1992691182",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "445 PARK AVE FL 9",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100228606",
            "telephone_number": "516-359-1066"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1433 N MAIN ST",
            "city": "BRYAN",
            "state": "OH",
            "postal_code": "435061053",
            "telephone_number": "419-633-9191",
            "fax_number": "419-633-3082"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER OPERATING FOUNTAIN PARK, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PREMIER SENIOR LIVING, LLC",
        "enumeration_date": "2025-06-16",
        "last_updated": "2026-05-26",
        "certification_date": "2026-05-26",
        "status": "A",
        "authorized_official_last_name": "KAPLAN",
        "authorized_official_first_name": "WAYNE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "516-359-1066",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Inn at Fountain Park",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Tiffany Rae Poletta, COTA/L
• Brianna Rae Pool, A-GNP
• Nicole Marie Pothast, MSN, CNM
• Rebecca Ann Powers, COTA/L
• Premier Operating Fountain Park, LLC
• Premier Operating Ohio, LLC
• Premier Operating Ohio, LLC
• Pro Rad, Inc
• Sharon A. Ransom, MD
• Doddipatala Rao, MD

• Assisted Living Facility in Bryan, OH
• Providers in Bryan, OH by specialty
• Assisted Living Facility in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2026; 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.