Healthcare Provider Details

I. General information

NPI: 1083602833
Provider Name (Legal Business Name): ALPINE VILLAGE RETIREMENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2005
Last Update Date: 04/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

706 JAMES ST
VERDIGRE NE
68783-6022
US

IV. Provider business mailing address

706 JAMES ST
VERDIGRE NE
68783-6022
US

V. Phone/Fax

Practice location:
  • Phone: 402-668-2209
  • Fax: 402-668-2335
Mailing address:
  • Phone: 402-668-2209
  • Fax: 402-668-2335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number494002
License Number StateNE

VIII. Authorized Official

Name: BRIAN VAKOC
Title or Position: ADMINISTRATOR
Credential:
Phone: 402-668-2209