Organization
CSL 108TH & Q, LLC
Active
Other names
The Waterford at Roxbury Park
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. GLORIA HOLLAND (VP-FINANCE)
(972) 770-5600
Entity
Organization
Contact information
Practice address
5728 S. 108TH STREET, OMAHA, NE 68137
(402) 537-0544
(402) 593-8010
Mailing address
14160 DALLAS PARKWAY, SUITE 300, DALLAS, TX 75254
(972) 770-5600
(972) 770-5666
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
ALF155
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100258494-00
—
NE
Enumeration date
07/06/2010
Last updated
07/06/2010
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