Healthcare Provider Details

I. General information

NPI: 1497048219
Provider Name (Legal Business Name): ST. JOSEPH TERRACE APARTMENTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2011
Last Update Date: 05/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2205 S 10TH ST
OMAHA NE
68108-1155
US

IV. Provider business mailing address

2205 S 10TH ST
OMAHA NE
68108-1155
US

V. Phone/Fax

Practice location:
  • Phone: 402-952-5000
  • Fax: 402-952-5117
Mailing address:
  • Phone: 402-952-5000
  • Fax: 402-952-5117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number265233
License Number StateNE

VIII. Authorized Official

Name: MRS. TRACY L. LICHTI
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 402-952-5000