Provider Demographics
NPI:1730425059
Name:THE WATERFORD MEMORY CARE SOUTH 27TH, INC.
Entity type:Organization
Organization Name:THE WATERFORD MEMORY CARE SOUTH 27TH, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:KLEIN
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:402-435-3550
Mailing Address - Street 1:1901 SW 5TH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68522-1754
Mailing Address - Country:US
Mailing Address - Phone:402-435-3550
Mailing Address - Fax:402-435-5070
Practice Address - Street 1:8939 KEYSTONE DR
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-4127
Practice Address - Country:US
Practice Address - Phone:402-421-8105
Practice Address - Fax:402-421-8106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-13
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEALF344311500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)