Active NPI
VSL Lincoln Southlake LLC
Doing business as Southlake Village
- Skilled Nursing Facility
- Lincoln, NE
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- License
- NH00011
- Legal business name
- VSL LINCOLN SOUTHLAKE LLC
- Doing business as
- Southlake Village
Southlake Village Rehabilitation and Care Center - Practice address
- 9401 Andermatt Dr
Lincoln, NE 68526-9507 - Phone
- (402) 476-3274
- Fax
- (402) 476-6395
- NPI assigned
- Jun 10, 2017
- Last updated
- Jul 24, 2025
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Jack D Vetter
- Title
- Ceo
- Phone
- (402) 895-3932
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | NH00011 | NE | Primary |
Addresses
Primary practice location
9401 Andermatt Dr
Lincoln, NE 68526-9507
Mailing address
20220 Harney St
Elkhorn, NE 68022-2063
Phone (402) 885-6120
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| NH00011 | Other | NE | FACILITY LICENSE |
Other names 2
- Southlake Village
- Southlake Village Rehabilitation and Care Center
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | https://199.119.81.30:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRResponse_Service | Other | eSolutions Inc. |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NE
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20170905002174 | NE | Part A Provider - Skilled Nursing Facility | 8123391604 | Practice locations: Lincoln, NE |
NPI to CCN mapping 1
The Medicare certification numbers (CCNs) connected to NPI 1316476559. Details of each certification follow.
Skilled nursing facility certification: CCN 285219
- Legal name
- VSL LINCOLN SOUTHLAKE LLC
- Doing business as
- SOUTHLAKE VILLAGE REHABILITATION & CARE CENTER
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- May 7, 1998
- Last certification
- Aug 13, 2024
- Beds
- 126
- Ownership / control type
- Nonprofit Corporation
- Multi-facility organization
- Vetter Senior Living
- Organization structure
- LLC
- Enrollment address
- 9401 Andermatt Dr
Lincoln, NE 68526-9507 - Nursing home name
- SOUTHLAKE VILLAGE REHABILITATION & CARE CENTER
- Affiliated entity
- VETTER SENIOR LIVING
Care Compare: Nursing home
Medicare Care Compare- Listed as
- Southlake Village Rehabilitation & Care Center
- Overall star rating
- Health inspections
- Staffing
- Quality measures
- Type
- Medicare and Medicaid
- Ownership
- Non profit - Corporation
- Certified
- May 7, 1998
- Medicare certification status
- Active
- Certified beds
- 126
- Chain
- Vetter Senior Living
National Provider Directory
National Provider DirectoryOwnership & related parties
All disclosed owners & managing parties 9
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| David E. Bergmann | Contracted Managing Employee | May 9, 2018 | |
| Operational/Managerial Control | May 9, 2018 | ||
| Aaron J Dunlap | Other | Jul 1, 2017 | |
| Glenn a Vanekeren | Contracted Managing Employee | Jul 1, 2017 | |
| Corporate Officer | Jun 15, 2017 | ||
| Operational/Managerial Control | Jul 1, 2017 | ||
| Jack D Vetter | Contracted Managing Employee | Jul 1, 2017 | |
| Corporate Officer | Jun 15, 2017 | ||
| Operational/Managerial Control | Jul 1, 2017 | ||
| Ted M Triggs | Contracted Managing Employee | Oct 1, 2018 | |
| Operational/Managerial Control | Oct 1, 2018 | ||
| Brian W Stuhr | Contracted Managing Employee | Jul 1, 2017 | |
| Corporate Officer | Jun 15, 2017 | ||
| Operational/Managerial Control | Jul 1, 2017 | ||
| Vetter Senior Living | 5% Or Greater Direct Ownership Interest | Dec 23, 2016 | 100% |
| Operational/Managerial Control | Dec 23, 2016 | ||
| VSL Vetter Health Services LLC | Operational/Managerial Control | Jul 1, 2017 | 100% |
| Eldora D Vetter | Contracted Managing Employee | Jul 1, 2017 | |
| Corporate Officer | Jun 15, 2017 | ||
| Operational/Managerial Control | Jul 1, 2017 |
Owners & managing parties with NPI records 1
Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.
-
- Internal Medicine Physician
- Lincoln, NE
- NPI 1003837626
Contracted Managing Employee, Operational/Managerial Control
Facilities with the same owner 28
Facilities that share an organizational owner with 5% or greater ownership or operational control.
-
dba Brookestone Home Health Care
- Home Health Agency
- Omaha, NE
- NPI 1598288789
Vetter Senior Living
-
dba Highland Park Care Center
- Skilled Nursing Facility
- Alliance, NE
- NPI 1578093811
Vetter Senior Living, VSL Vetter Health Services LLC
-
dba Brookestone View
- Skilled Nursing Facility
- Broken Bow, NE
- NPI 1972032555
Vetter Senior Living, VSL Vetter Health Services LLC
-
dba Brookestone Acres
- Skilled Nursing Facility
- Columbus, NE
- NPI 1598295016
Vetter Senior Living, VSL Vetter Health Services LLC
-
dba Brookestone Of David City
- Skilled Nursing Facility
- David City, NE
- NPI 1306376074
Vetter Senior Living, VSL Vetter Health Services LLC
-
dba Brookestone Meadows
- Skilled Nursing Facility
- Elkhorn, NE
- NPI 1134658719
Vetter Senior Living, VSL Vetter Health Services LLC
-
dba Heritage of Emerson
- Skilled Nursing Facility
- Emerson, NE
- NPI 1669902334
Vetter Senior Living, VSL Vetter Health Services LLC
-
dba Heritage Care Center
- Skilled Nursing Facility
- Fairbury, NE
- NPI 1558891796
Vetter Senior Living, VSL Vetter Health Services LLC
-
dba Heritage Crossings
- Skilled Nursing Facility
- Geneva, NE
- NPI 1215467840
Vetter Senior Living, VSL Vetter Health Services LLC
-
dba Heritage Estates
- Skilled Nursing Facility
- Gering, NE
- NPI 1053840298
Vetter Senior Living, VSL Vetter Health Services LLC
-
dba Tiffany Square
- Skilled Nursing Facility
- Grand Island, NE
- NPI 1326578956
Vetter Senior Living, VSL Vetter Health Services LLC
-
dba Brookestone Gardens
- Skilled Nursing Facility
- Kearney, NE
- NPI 1437618576
Vetter Senior Living, VSL Vetter Health Services LLC
Practitioners & affiliated clinicians
Practitioners 3
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- Internal Medicine Physician
- Lincoln, NE
- NPI 1033208087
-
- Internal Medicine Physician
- Lincoln, NE
- NPI 1043253222
-
- Nurse Practitioner
- Omaha, NE
- NPI 1740504810
Affiliated clinicians 11
Clinicians who list this facility as an affiliation in Medicare Care Compare.
-
- Acute Care Nurse Practitioner
- Lincoln, NE
- NPI 1891117354
Nursing home
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1497052800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1753315200000",
"number": "1316476559",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "20220 HARNEY ST",
"city": "ELKHORN",
"state": "NE",
"postal_code": "680222063",
"telephone_number": "402-885-6120",
"fax_number": "402-895-8165"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9401 ANDERMATT DR",
"city": "LINCOLN",
"state": "NE",
"postal_code": "685269507",
"telephone_number": "402-476-3274",
"fax_number": "402-476-6395"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "VSL LINCOLN SOUTHLAKE LLC",
"organizational_subpart": "NO",
"enumeration_date": "2017-06-10",
"last_updated": "2025-07-24",
"certification_date": "2025-07-24",
"status": "A",
"authorized_official_last_name": "VETTER",
"authorized_official_first_name": "JACK",
"authorized_official_middle_name": "D",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "402-895-3932"
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": "NE",
"license": "NH00011",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FACILITY LICENSE",
"identifier": "NH00011",
"state": "NE"
}
],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "https://199.119.81.30:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRResponse_Service",
"affiliation": "Y",
"endpointDescription": "2.16.840.1.113883.3.1066.1",
"affiliationName": "eSolutions Inc.",
"use": "OTHER",
"useDescription": "Other",
"useOtherDescription": "CMS esMD eMDR",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "CSV",
"address_1": "8215 W 108th Ter",
"city": "Overland Park",
"state": "KS",
"country_code": "US",
"postal_code": "662101661",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": [
{
"organization_name": "Southlake Village",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Southlake Village",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Southlake Village Rehabilitation and Care Center",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Lincoln, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.