Healthcare Provider Details

I. General information

NPI: 1154702611
Provider Name (Legal Business Name): KINGSWOOD COURT ASSISTED LIVING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2015
Last Update Date: 03/10/2023
Certification Date: 03/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 IDAHO ST
SUPERIOR NE
68978-1103
US

IV. Provider business mailing address

1005 IDAHO ST
SUPERIOR NE
68978-1103
US

V. Phone/Fax

Practice location:
  • Phone: 402-207-1050
  • Fax: 402-207-1052
Mailing address:
  • Phone: 402-207-1050
  • Fax: 402-207-1052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberALF353
License Number StateNE

VIII. Authorized Official

Name: MICHELLE ANN SORSEN
Title or Position: CEO
Credential:
Phone: 402-759-6208