1730873530 NPI number — CEDARHURST OF LA VISTA OPERATOR, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730873530 NPI number — CEDARHURST OF LA VISTA OPERATOR, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CEDARHURST OF LA VISTA OPERATOR, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730873530
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/05/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 HUNTER AVE STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63124-2328
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-254-8354
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8140 S 97TH PLZ
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LA VISTA
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68128-7104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-597-0700
Provider Business Practice Location Address Fax Number:
402-488-0406
Provider Enumeration Date:
06/05/2023

Additional Information

Authorized Official

Authorized Official Last Name:
RICCI
Authorized Official First Name:
ALEXANDRA
Authorized Official Middle Name:
NOEL
Authorized Official Title or Position:
CORPORATE COUNSEL
Authorized Official Telephone Number:
314-254-8354

Provider Taxonomy Codes

  • Taxonomy code: 310400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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