Provider Demographics
NPI:1326318536
Name:THE WATERFORD CARE FACILITY AT COLLEGE VIEW
Entity Type:Organization
Organization Name:THE WATERFORD CARE FACILITY AT COLLEGE VIEW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DEB
Authorized Official - Middle Name:
Authorized Official - Last Name:MAGUIRE
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:402-434-2680
Mailing Address - Street 1:4848 S 48TH ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-1290
Mailing Address - Country:US
Mailing Address - Phone:402-434-2680
Mailing Address - Fax:402-434-2683
Practice Address - Street 1:4848 S 48TH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-1290
Practice Address - Country:US
Practice Address - Phone:402-434-2680
Practice Address - Fax:402-434-2683
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-04
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEALF 076310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47-0760634-04Medicaid