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General NPI Number Information
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NPI Number | 1063080323
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Entity Type | Organization
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Legal Business Name | LAVISTA SENIOR HOUSING, LLC
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Dates
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Enumeration Date | 06/14/2021
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Last Update Date | 06/14/2021
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Provider Practice Location Address
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Address Line | 8140 S 97TH PLZ
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City | LA VISTA
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State | NE
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Zip | 68128-7104
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Country | US
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Telephone | 402-597-0700
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Fax |
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Provider Business Mailing Address
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Address Line | 8140 S 97TH PLZ
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City | LA VISTA
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State | NE
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Zip | 68128-7104
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | STACY L RANDELS
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Credential |
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Telephone | 531-800-3364
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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