Provider Demographics
NPI:1194480467
Name:PREMIER HEALTHCARE MANAGEMENT OF PAYNESVILLE LLC
Entity type:Organization
Organization Name:PREMIER HEALTHCARE MANAGEMENT OF PAYNESVILLE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SEC/TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:FRED
Authorized Official - Middle Name:
Authorized Official - Last Name:STRUZYK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-249-7364
Mailing Address - Street 1:800 WASHBURNE AVE
Mailing Address - Street 2:
Mailing Address - City:PAYNESVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:56362-1810
Mailing Address - Country:US
Mailing Address - Phone:320-340-6283
Mailing Address - Fax:
Practice Address - Street 1:311 WASHBURNE AVE
Practice Address - Street 2:
Practice Address - City:PAYNESVILLE
Practice Address - State:MN
Practice Address - Zip Code:56362-1658
Practice Address - Country:US
Practice Address - Phone:320-340-6283
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-02
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility