WC-Granville Villa Ops, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

WC-GRANVILLE VILLA OPS, LLC

Practice address

8507 Granville Pkwy
La Vista, NE 68128-3212

Phone

(402) 933-6405

Fax

(402) 505-9144

NPI assigned

Oct 29, 2014

Organization subpart

No

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

Authorized official

Name

Collette Mieres

Title

Executive Director

Phone

(402) 933-6405

Specialties & licenses 1

Addresses

Other names 1

• Granville Villa Assisted Living Doing business as

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

{
    "created_epoch": "1414540800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1423180800000",
    "number": "1770988941",
    "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",
            "fax_number": "402-505-9144"
        },
        {
            "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",
            "fax_number": "402-505-9144"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WC-GRANVILLE VILLA OPS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-29",
        "last_updated": "2015-02-06",
        "status": "A",
        "authorized_official_last_name": "MIERES",
        "authorized_official_first_name": "COLLETTE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "402-933-6405"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Granville Villa 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 Feb 6, 2015; 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.