# WAUSA LEISURE LIVING, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Countryside Villa
- **Organization subpart:** No

## Provider details

- **NPI number:** 1477627677
- **Authorized official:** MS. JEAN M HOLCOMB (ADMINISTRATOR)
- **Authorized official phone:** (402) 586-2890

## Contact information

- **Practice address:** 803 S VIVIAN ST, WAUSA, NE 68786-2046
- **Practice address phone:** (402) 586-2890
- **Practice address fax:** (402) 586-2945
- **Mailing address:** 803 S VIVIAN ST, WAUSA, NE 68786-2046
- **Mailing address phone:** (402) 586-2890
- **Mailing address fax:** (402) 586-2945

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 310400000X | Assisted Living Facility | ALF232 | NE | Yes |

## Other

- **Enumeration date:** 11/20/2006
- **Last updated:** 08/22/2020