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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