Provider Demographics
NPI:1548925498
Name:HILLCREST MABLE ROSE, LLC
Entity type:Organization
Organization Name:HILLCREST MABLE ROSE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHARYL
Authorized Official - Middle Name:
Authorized Official - Last Name:RONAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-682-4800
Mailing Address - Street 1:1902 HARLAN DR STE A
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68005-6609
Mailing Address - Country:US
Mailing Address - Phone:402-682-4201
Mailing Address - Fax:
Practice Address - Street 1:4609 HILLTOP ST
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68133-3323
Practice Address - Country:US
Practice Address - Phone:402-291-9777
Practice Address - Fax:402-682-6816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-05
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care