# GOTTENBURG SENIOR LIVING, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1215235023
- **Authorized official:** MRS. DEBORAH LOUISE BACON (OWNER)
- **Authorized official phone:** (308) 537-7161

## Contact information

- **Practice address:** 110 20TH STREET, GOTHENBURG, NE 69138
- **Practice address phone:** (308) 537-7771
- **Practice address fax:** (308) 537-7787
- **Mailing address:** 110 20TH STREET, GOTHENBURG, NE 69138
- **Mailing address phone:** (308) 537-7771
- **Mailing address fax:** (308) 537-7787

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 310400000X | Assisted Living Facility | — | NULL | Yes |

## Other

- **Enumeration date:** 03/02/2011
- **Last updated:** 03/02/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 100253132-00 | — | NE |