Grand Island Countryhouse LLC

Primary specialty

Alzheimer Center (Dementia Center)Taxonomy code 311500000X

License

ALF300 Issued in NE

Legal business name

GRAND ISLAND COUNTRYHOUSE LLC

Practice address

833 N Alpha St
Grand Island, NE 68803-4321

Phone

(308) 381-1988

Fax

(308) 381-4005

NPI assigned

Apr 29, 2011

Organization subpart

Yes

Parent organization

AGEMARK CORPORATIONAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Stacy Glock

Title

Executive Director

Phone

(308) 381-1988

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1304035200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1304035200000",
    "number": "1265723829",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "833 N ALPHA ST",
            "city": "GRAND ISLAND",
            "state": "NE",
            "postal_code": "688034321",
            "telephone_number": "308-381-1988",
            "fax_number": "308-381-4005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "833 N ALPHA ST",
            "city": "GRAND ISLAND",
            "state": "NE",
            "postal_code": "688034321",
            "telephone_number": "308-381-1988",
            "fax_number": "308-381-4005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAND ISLAND COUNTRYHOUSE LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "AGEMARK CORPORATION",
        "enumeration_date": "2011-04-29",
        "last_updated": "2011-04-29",
        "status": "A",
        "authorized_official_last_name": "GLOCK",
        "authorized_official_first_name": "STACY",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "308-381-1988"
    },
    "taxonomies": [
        {
            "code": "311500000X",
            "taxonomy_group": "",
            "desc": "Alzheimer Center (Dementia Center)",
            "state": "NE",
            "license": "ALF300",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Grand Island Health and Rehab LLC
• Grand Island Health Care Inc

• Alzheimer Center (Dementia Center) in Grand Island, NE
• Providers in Grand Island, NE by specialty
• Alzheimer Center (Dementia Center) in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.