CSL 108TH & Q, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

ALF155 Issued in NE

Legal business name

CSL 108TH & Q, LLC

Doing business as

The Waterford at Roxbury Park

Practice address

5728 S. 108TH Street
Omaha, NE 68137

Phone

(402) 537-0544

Fax

(402) 593-8010

NPI assigned

Jul 6, 2010

Organization subpart

No

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

Authorized official

Name

Mrs. Gloria Holland

Title

VP-Finance

Phone

(972) 770-5600

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• The Waterford at Roxbury Park Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

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

{
    "created_epoch": "1278374400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1278374400000",
    "number": "1427360569",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14160 DALLAS PARKWAY",
            "address_2": "SUITE 300",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "75254",
            "telephone_number": "972-770-5600",
            "fax_number": "972-770-5666"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5728 S. 108TH STREET",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "68137",
            "telephone_number": "402-537-0544",
            "fax_number": "402-593-8010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CSL 108TH & Q, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-07-06",
        "last_updated": "2010-07-06",
        "status": "A",
        "authorized_official_last_name": "HOLLAND",
        "authorized_official_first_name": "GLORIA",
        "authorized_official_title_or_position": "VP-FINANCE",
        "authorized_official_telephone_number": "972-770-5600",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "NE",
            "license": "ALF155",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100258494-00",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Waterford at Roxbury Park",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Assisted Living Facility in Omaha, NE
• Providers in Omaha, NE by specialty
• Assisted Living Facility in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• 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.

Verify at the official NPI Registry.