Midwest Care Granville Villa LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

305S00000X Issued in NE

Legal business name

MIDWEST CARE GRANVILLE VILLA LLC

Practice address

8507 Granville Pkwy
La Vista, NE 68128-3212

Phone

(402) 933-6405

NPI assigned

Jul 25, 2011

Organization subpart

No

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

Authorized official

Name

Mr. Jonathan Matthew Ohlsen-Johnson, J.D.

Title

General Counsel

Phone

(541) 543-1215

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Granville Assisted Living Doing business as

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

{
    "created_epoch": "1311552000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1311552000000",
    "number": "1578841599",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8507 GRANVILLE PKWY",
            "city": "LA VISTA",
            "state": "NE",
            "postal_code": "681283212",
            "telephone_number": "402-933-6405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8507 GRANVILLE PKWY",
            "city": "LA VISTA",
            "state": "NE",
            "postal_code": "681283212",
            "telephone_number": "402-933-6405"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIDWEST CARE GRANVILLE VILLA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-07-25",
        "last_updated": "2011-07-25",
        "status": "A",
        "authorized_official_last_name": "OHLSEN-JOHNSON",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_middle_name": "MATTHEW",
        "authorized_official_title_or_position": "GENERAL COUNSEL",
        "authorized_official_telephone_number": "541-543-1215",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "J.D."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "NE",
            "license": "305S00000X",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10025786100",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Granville Assisted Living",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Assisted Living Facility in La Vista, NE
• Providers in La Vista, 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 25, 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.