Wausa Leisure Living, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

ALF232 Issued in NE

Legal business name

WAUSA LEISURE LIVING, LLC

Doing business as

Countryside Villa

Practice address

803 S Vivian St
Wausa, NE 68786-2046

Phone

(402) 586-2890

Fax

(402) 586-2945

NPI assigned

Nov 20, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ms. Jean M Holcomb

Title

Administrator

Phone

(402) 586-2890

Specialties & licenses 1

Addresses

Other names 1

• Countryside Villa Doing business as

Locations

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

{
    "created_epoch": "1163980800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1477627677",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "803 S VIVIAN ST",
            "city": "WAUSA",
            "state": "NE",
            "postal_code": "687862046",
            "telephone_number": "402-586-2890",
            "fax_number": "402-586-2945"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "803 S VIVIAN ST",
            "city": "WAUSA",
            "state": "NE",
            "postal_code": "687862046",
            "telephone_number": "402-586-2890",
            "fax_number": "402-586-2945"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAUSA LEISURE LIVING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-20",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HOLCOMB",
        "authorized_official_first_name": "JEAN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "402-586-2890",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "NE",
            "license": "ALF232",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Countryside Villa",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Buffy Joe Schaecher
• School District 76R (Wausa Public Schools)
• Makenzie V Vaughn
• Angela Dee Wamberg
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• Amber Dawn Weideman
• Tina Williams, LIMHP, LMHP, LPC

• Assisted Living Facility in Wausa, NE
• Providers in Wausa, 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 Aug 22, 2020; 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.