Provider Demographics
NPI:1063465516
Name:LIFESPACE COMMUNITIES INC
Entity Type:Organization
Organization Name:LIFESPACE COMMUNITIES INC
Other - Org Name:GRAND LODGE AT THE PRESERVE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-288-5805
Mailing Address - Street 1:4400 S 80TH ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-4456
Mailing Address - Country:US
Mailing Address - Phone:402-489-8003
Mailing Address - Fax:402-489-9956
Practice Address - Street 1:4400 S 80TH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-4456
Practice Address - Country:US
Practice Address - Phone:402-489-8003
Practice Address - Fax:402-489-9956
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIFESPACE COMMUNITIES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-18
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEALF286310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility