Provider Demographics
NPI:1427129899
Name:PREMIER ESTATES OF MUSCATINE, LLC
Entity type:Organization
Organization Name:PREMIER ESTATES OF MUSCATINE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:S
Authorized Official - Last Name:BENCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-391-2373
Mailing Address - Street 1:3440 MULBERRY AVE
Mailing Address - Street 2:
Mailing Address - City:MUSCATINE
Mailing Address - State:IA
Mailing Address - Zip Code:52761-2323
Mailing Address - Country:US
Mailing Address - Phone:563-263-2194
Mailing Address - Fax:563-263-2253
Practice Address - Street 1:3440 MULBERRY AVE
Practice Address - Street 2:
Practice Address - City:MUSCATINE
Practice Address - State:IA
Practice Address - Zip Code:52761-2323
Practice Address - Country:US
Practice Address - Phone:563-263-2194
Practice Address - Fax:563-263-2253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-10
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0800108Medicaid
IA0809913Medicaid
IA0800108Medicaid