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General NPI Number Information
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NPI Number | 1467096446
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Entity Type | Organization
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Legal Business Name | THE HERITAGE AT SAGEWOOD OPERATING , LLC
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Dates
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Enumeration Date | 11/01/2019
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Last Update Date | 11/01/2019
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Provider Practice Location Address
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Address Line | 1920 SAGEWOOD AVE
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City | GRAND ISLAND
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State | NE
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Zip | 68803-1585
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Country | US
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Telephone | 308-398-8005
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Fax | 308-675-3325
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Provider Business Mailing Address
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Address Line | 16934 FRANCES ST STE 200
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City | OMAHA
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State | NE
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Zip | 68130-2397
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Country | US
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Telephone | 402-933-2561
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Fax | 402-933-2673
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | BRANDI CORNWELL
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Credential |
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Telephone | 308-398-8005
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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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