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Organization
GRAND ISLAND COUNTRYHOUSE LLC
Active
Organization
GRAND ISLAND COUNTRYHOUSE LLC
Active
Parent organization
AGEMARK CORPORATION
Organization subpart
Yes
Provider details
NPI number
Legal business name
AGEMARK CORPORATION
Authorized official
STACY GLOCK (EXECUTIVE DIRECTOR)
(308) 381-1988
Entity
Organization
Contact information
Practice address
833 N ALPHA ST, GRAND ISLAND, NE 68803-4321
(308) 381-1988
(308) 381-4005
Mailing address
833 N ALPHA ST, GRAND ISLAND, NE 68803-4321
(308) 381-1988
(308) 381-4005
Taxonomy
Speciality
Code
Description
License number
State
311500000X
Alzheimer Center (Dementia Center)
Primary
ALF300
NE
Other
Enumeration date
04/29/2011
Last updated
04/29/2011
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