Healthcare Provider Details

I. General information

NPI: 1306927751
Provider Name (Legal Business Name): PARKVIEW LODGE ASSITED LIVING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 CONRAD
RUSHVILLE NE
69360-0129
US

IV. Provider business mailing address

307 CONRAD P O BOX 129
RUSHVILLE NE
69360-0129
US

V. Phone/Fax

Practice location:
  • Phone: 308-327-2248
  • Fax: 308-327-2248
Mailing address:
  • Phone: 308-327-2248
  • Fax: 308-327-2248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberAFL129
License Number StateNE

VIII. Authorized Official

Name: MS. BARBARA JOHNDREAU
Title or Position: ADMINISTRATOR
Credential: RN, ADM
Phone: 308-327-2248