Organization
LEGACY TERRACE L.P.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN KOPETZKY (EXECUTIVE DIRECTOR)
(402) 464-5700
Entity
Organization
Contact information
Practice address
5700 FREMONT ST, LINCOLN, NE 68507-1674
(402) 464-5700
Mailing address
5700 FREMONT ST, LINCOLN, NE 68507-1674
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
ALF096
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ALF096
STATE OF NEBRASKA HEALTH AND HUMAN SERVICES
—
Enumeration date
01/06/2011
Last updated
01/06/2011
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