Organization
LOGAN VALLEY MANOR LLC
Active
Other names
Logan Valley Manor
Organization subpart
No
Provider details
NPI number
Authorized official
GARETT J ROBERTSON (CEO)
(801) 296-5105
Entity
Organization
Contact information
Practice address
1035 DIAMOND ST, LYONS, NE 68038-2501
(402) 687-2636
(402) 687-2638
Mailing address
1035 DIAMOND ST, LYONS, NE 68038-2501
(402) 387-2636
(402) 687-2638
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
084001
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10026103200
—
NE
Enumeration date
08/04/2010
Last updated
01/20/2012
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