Provider Demographics
NPI:1164725958
Name:THE WATERFORD GROUP, INC.
Entity Type:Organization
Organization Name:THE WATERFORD GROUP, INC.
Other - Org Name:THE WATERFORD AT WILLIAMSBURG
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
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 1:3940 PINE LAKE RD
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-5485
Practice Address - Country:US
Practice Address - Phone:402-423-0000
Practice Address - Fax:402-423-1601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-16
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEALF183310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility