Provider Demographics
NPI:1467808329
Name:PREMIER OPERATING COUNTRYSIDE VILLAGE, LLC
Entity Type:Organization
Organization Name:PREMIER OPERATING COUNTRYSIDE VILLAGE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:BORSODY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-739-0794
Mailing Address - Street 1:5383 US HIGHWAY 117 N
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27863-9443
Mailing Address - Country:US
Mailing Address - Phone:919-242-6369
Mailing Address - Fax:919-242-9884
Practice Address - Street 1:5383 US HIGHWAY 117 N
Practice Address - Street 2:
Practice Address - City:PIKEVILLE
Practice Address - State:NC
Practice Address - Zip Code:27863-9443
Practice Address - Country:US
Practice Address - Phone:919-242-6369
Practice Address - Fax:919-242-9884
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PREMIER SENIOR LIVING, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-05-10
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home