Basic Information
| Provider Information | |||||||||
| NPI: | 1104388040 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GRAND ISLAND PARK OPERATIONS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 610 N DARR AVE | ||||||||
| Address2: | |||||||||
| City: | GRAND ISLAND | ||||||||
| State: | NE | ||||||||
| PostalCode: | 688034635 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 610 N DARR AVE | ||||||||
| Address2: | |||||||||
| City: | GRAND ISLAND | ||||||||
| State: | NE | ||||||||
| PostalCode: | 688034635 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3083822635 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/01/2019 | ||||||||
| LastUpdateDate: | 04/01/2019 | ||||||||
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| AuthorizedOfficialLastName: | LAHASKY | ||||||||
| AuthorizedOfficialFirstName: | EPHRAM | ||||||||
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| AuthorizedOfficialTitleorPosition: | MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 6467723668 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.