Healthcare Provider Details

I. General information

NPI: 1104388040
Provider Name (Legal Business Name): GRAND ISLAND PARK OPERATIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2019
Last Update Date: 04/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 N DARR AVE
GRAND ISLAND NE
68803-4635
US

IV. Provider business mailing address

610 N DARR AVE
GRAND ISLAND NE
68803-4635
US

V. Phone/Fax

Practice location:
  • Phone: 308-382-2635
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: EPHRAM LAHASKY
Title or Position: MEMBER
Credential:
Phone: 646-772-3668