Provider Demographics
NPI:1093171795
Name:PREMIER ESTATES 511, LLC
Entity Type:Organization
Organization Name:PREMIER ESTATES 511, LLC
Other - Org Name:CEDAR FALLS HEALTH CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CULP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-758-4745
Mailing Address - Street 1:5115 E STATE ROAD 64
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208-5509
Mailing Address - Country:US
Mailing Address - Phone:941-758-4745
Mailing Address - Fax:941-751-2135
Practice Address - Street 1:1728 W 8TH ST
Practice Address - Street 2:
Practice Address - City:CEDAR FALLS
Practice Address - State:IA
Practice Address - Zip Code:50613-2002
Practice Address - Country:US
Practice Address - Phone:319-277-2437
Practice Address - Fax:319-266-1082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-11
Last Update Date:2016-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA070215314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0800178Medicaid