Provider Demographics
NPI:1992691182
Name:PREMIER OPERATING FOUNTAIN PARK, LLC
Entity type:Organization
Organization Name:PREMIER OPERATING FOUNTAIN PARK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:KAPLAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-359-1066
Mailing Address - Street 1:445 PARK AVE FL 9
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-8606
Mailing Address - Country:US
Mailing Address - Phone:561-359-1066
Mailing Address - Fax:
Practice Address - Street 1:1433 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:OH
Practice Address - Zip Code:43506-1053
Practice Address - Country:US
Practice Address - Phone:419-633-9191
Practice Address - Fax:419-633-3082
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PREMIER SENIOR LIVING, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-06-16
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility