5410 17TH Ave NE Opco LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

5410 17TH AVE NE OPCO LLC

Practice address

5410 17TH Ave
Kearney, NE 68845-8305

Phone

(316) 239-6662

NPI assigned

Dec 17, 2024

Organization subpart

No

Name

Laura Gamble

Title

Senior Account Manager

Phone

(316) 239-6662

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

CLIA laboratory certificates

• KINSHIP POINTE NORTHRIDGE Doing business as

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Dec 18, 2024.

{
    "created_epoch": "1734393600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1734480000000",
    "number": "1619784147",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "333 S BROADWAY AVE",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672024300",
            "telephone_number": "316-239-6662"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5410 17TH AVE",
            "city": "KEARNEY",
            "state": "NE",
            "postal_code": "688458305",
            "telephone_number": "316-239-6662"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "5410 17TH AVE NE OPCO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-12-17",
        "last_updated": "2024-12-18",
        "certification_date": "2024-12-18",
        "status": "A",
        "authorized_official_last_name": "GAMBLE",
        "authorized_official_first_name": "LAURA",
        "authorized_official_title_or_position": "SENIOR ACCOUNT MANAGER",
        "authorized_official_telephone_number": "316-239-6662"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "KINSHIP POINTE NORTHRIDGE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• All providers in Kearney, NE
• Assisted Living Facility in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2024; 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.