# HILLCREST SHADOW LAKE, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Hillcrest Shadow Lake
- **Organization subpart:** No

## Provider details

- **NPI number:** 1245997436
- **Authorized official:** JOLENE L MATHISON ROBERTS (PRESIDENT)
- **Authorized official phone:** (402) 682-4800

## Contact information

- **Practice address:** 1507 E GOLD COAST RD, PAPILLION, NE 68046-4722
- **Practice address phone:** (402) 339-6010
- **Mailing address:** 1902 HARLAN DR STE A, BELLEVUE, NE 68005-6609
- **Mailing address phone:** (402) 682-4201

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | — | NULL | Yes |

## Other

- **Enumeration date:** 11/22/2021
- **Last updated:** 11/22/2021