Organization
GOTTENBURG SENIOR LIVING, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DEBORAH LOUISE BACON (OWNER)
(308) 537-7161
Entity
Organization
Contact information
Practice address
110 20TH STREET, GOTHENBURG, NE 69138
(308) 537-7771
(308) 537-7787
Mailing address
110 20TH STREET, GOTHENBURG, NE 69138
(308) 537-7771
(308) 537-7787
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100253132-00
—
NE
Enumeration date
03/02/2011
Last updated
03/02/2011
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