Provider Demographics
NPI:1760075717
Name:PRIMGHAR SNF OPERATOR LLC
Entity Type:Organization
Organization Name:PRIMGHAR SNF OPERATOR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ATTORNEY
Authorized Official - Prefix:MR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:WERTHEIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-347-9453
Mailing Address - Street 1:15310 AMBERLY DR STE 102
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-2145
Mailing Address - Country:US
Mailing Address - Phone:813-347-9453
Mailing Address - Fax:
Practice Address - Street 1:735 N RERICK AVE
Practice Address - Street 2:
Practice Address - City:PRIMGHAR
Practice Address - State:IA
Practice Address - Zip Code:51245-1052
Practice Address - Country:US
Practice Address - Phone:712-957-3655
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-19
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility