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General NPI Number Information
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NPI Number | 1487877510
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Entity Type | Organization
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Legal Business Name | GARDEN SQUARE LLC
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Dates
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Enumeration Date | 04/10/2007
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Last Update Date | 06/24/2008
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Provider Practice Location Address
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Address Line | 1405 HICKORY AVE
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City | CRETE
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State | NE
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Zip | 68333-1955
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Country | US
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Telephone | 402-826-2241
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Fax | 402-826-2775
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Provider Business Mailing Address
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Address Line | 1405 HICKORY AVE
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City | CRETE
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State | NE
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Zip | 68333-1955
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Country | US
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Telephone | 402-826-2241
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Fax | 402-826-2775
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. KIMBERLY A SASEK
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Credential |
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Telephone | 402-826-2241
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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 | ALF063
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License Number State | NE
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