Healthcare Provider Details

I. General information

NPI: 1760780936
Provider Name (Legal Business Name): SILVERCREST FOUNTAIN VIEW INDEPENDENT, LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2011
Last Update Date: 03/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5710 S 108TH ST
OMAHA NE
68137-3592
US

IV. Provider business mailing address

5710 S 108TH ST
OMAHA NE
68137-3592
US

V. Phone/Fax

Practice location:
  • Phone: 402-596-9033
  • Fax: 402-932-3997
Mailing address:
  • Phone: 402-596-9033
  • Fax: 402-932-3997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberALF292
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License NumberALF292
License Number StateNE

VIII. Authorized Official

Name: MR. GEORGE A BAKHIT
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 402-596-9033