MEDICARE: LEXINGTON SENIOR LIVING LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility
2	310400000X	Assisted Living Facility	ALF-125	NE

General Provider Information

NPI Number	:	1871610659
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEXINGTON SENIOR LIVING LLC

Provider Business Mailing Address
First Line	:	PO BOX 3006
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97302-0006
Country	:	US
Telephone Number	:	503-375-9016
Fax Number	:	503-485-1279

Provider Business Practice Location Address
First Line	:	1811 RIDGEWAY DR
Second Line	:
City	:	LEXINGTON
State	:	NE
Zip	:	68850-1188
Country	:	US
Telephone Number	:	308-324-5490
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	JON M HARDER
Credential	:
Telephone Number	:	503-375-9016

Provider Enumeration Date	:	03/25/2007
Last Update Date	:	07/14/2008

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Directions to “LEXINGTON SENIOR LIVING LLC ” Practice Location

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