Organization
MIDWEST CARE GRANVILLE VILLA LLC
Active
Other names
Granville Assisted Living
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JONATHAN MATTHEW OHLSEN-JOHNSON J.D. (GENERAL COUNSEL)
(541) 543-1215
Entity
Organization
Contact information
Practice address
8507 GRANVILLE PKWY, LA VISTA, NE 68128-3212
(402) 933-6405
Mailing address
8507 GRANVILLE PKWY, LA VISTA, NE 68128-3212
(402) 933-6405
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
305S00000X
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10025786100
—
NE
Enumeration date
07/25/2011
Last updated
07/25/2011
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