# CSL 108TH & Q, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** The Waterford at Roxbury Park
- **Organization subpart:** No

## Provider details

- **NPI number:** 1427360569
- **Authorized official:** MRS. GLORIA HOLLAND (VP-FINANCE)
- **Authorized official phone:** (972) 770-5600

## Contact information

- **Practice address:** 5728 S. 108TH STREET, OMAHA, NE 68137
- **Practice address phone:** (402) 537-0544
- **Practice address fax:** (402) 593-8010
- **Mailing address:** 14160 DALLAS PARKWAY, SUITE 300, DALLAS, TX 75254
- **Mailing address phone:** (972) 770-5600
- **Mailing address fax:** (972) 770-5666

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 310400000X | Assisted Living Facility | ALF155 | NE | Yes |

## Other

- **Enumeration date:** 07/06/2010
- **Last updated:** 07/06/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 100258494-00 | — | NE |