Logan Valley Manor LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

084001 Issued in NE

Legal business name

LOGAN VALLEY MANOR LLC

Doing business as

Logan Valley Manor

Practice address

1035 Diamond St
Lyons, NE 68038-2501

Phone

(402) 687-2636

Fax

(402) 687-2638

NPI assigned

Aug 4, 2010

Organization subpart

No

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

Authorized official

Name

Garett J Robertson

Title

Ceo

Phone

(801) 296-5105

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Logan Valley Manor Doing business as

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

{
    "created_epoch": "1280880000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1327017600000",
    "number": "1396059051",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1035 DIAMOND ST",
            "city": "LYONS",
            "state": "NE",
            "postal_code": "680382501",
            "telephone_number": "402-387-2636",
            "fax_number": "402-687-2638"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1035 DIAMOND ST",
            "city": "LYONS",
            "state": "NE",
            "postal_code": "680382501",
            "telephone_number": "402-687-2636",
            "fax_number": "402-687-2638"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOGAN VALLEY MANOR LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-08-04",
        "last_updated": "2012-01-20",
        "status": "A",
        "authorized_official_last_name": "ROBERTSON",
        "authorized_official_first_name": "GARETT",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "801-296-5105"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NE",
            "license": "084001",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10026103200",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Logan Valley Manor",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Alex Anita Anderson
• Baum Harmon Mercy Hospital (MercyOne Lyons Family Medicine)
• Happy Days Senior Center
• Jennifer Anne Hollis
• Improve Care Management and Rehab Consultant Inc (Lyons Living Center)
• Lyons Community Foundation
• Lyons Fire District (Lyons Volunteer Fire and Rescue)
• Lyons-Decatur Northeast Public Schools
• Lisa Denise McCreary
• Jeremy Miles

• Skilled Nursing Facility in Lyons, NE
• Providers in Lyons, NE by specialty
• Skilled Nursing Facility in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2012; 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.