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General NPI Number Information
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NPI Number | 1477077808
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Entity Type | Organization
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Legal Business Name | LINCOLN COUNTRYHOUSE III, LLC
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Dates
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Enumeration Date | 07/27/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 240 S 70TH ST
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City | LINCOLN
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State | NE
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Zip | 68510-2406
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Country | US
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Telephone | 402-421-2200
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Fax | 531-289-1494
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Provider Business Mailing Address
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Address Line | 240 S 70TH ST
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City | LINCOLN
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State | NE
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Zip | 68510-2406
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Country | US
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Telephone | 402-421-2200
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Fax | 531-289-1494
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | SUZY JESSICA NOOTZ
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Credential |
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Telephone | 402-421-2200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number | ALF369
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License Number State | NE
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