# MIDWEST CARE GRANVILLE VILLA LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Granville Assisted Living
- **Organization subpart:** No

## Provider details

- **NPI number:** 1578841599
- **Authorized official:** MR. JONATHAN MATTHEW OHLSEN-JOHNSON J.D. (GENERAL COUNSEL)
- **Authorized official phone:** (541) 543-1215

## Contact information

- **Practice address:** 8507 GRANVILLE PKWY, LA VISTA, NE 68128-3212
- **Practice address phone:** (402) 933-6405
- **Mailing address:** 8507 GRANVILLE PKWY, LA VISTA, NE 68128-3212
- **Mailing address phone:** (402) 933-6405

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 310400000X | Assisted Living Facility | 305S00000X | NE | Yes |

## Other

- **Enumeration date:** 07/25/2011
- **Last updated:** 07/25/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 10025786100 | — | NE |