Healthcare Provider Details

I. General information

NPI: 1538070537
Provider Name (Legal Business Name): PAPILLION GRAND LODGE OPERATING COMPANY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6021 GRAND LODGE AVE
PAPILLION NE
68133-3205
US

IV. Provider business mailing address

6021 GRAND LODGE AVE
PAPILLION NE
68133-3206
US

V. Phone/Fax

Practice location:
  • Phone: 917-745-7945
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: YOSEF EMANUEL
Title or Position: PRINICPAL
Credential:
Phone: 917-745-7945