Provider Demographics
NPI:1356638175
Name:CITY OF GENOA
Entity Type:Organization
Organization Name:CITY OF GENOA
Other - Org Name:LOOKING GLASS ESTATES
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROEBUCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-993-4583
Mailing Address - Street 1:PO BOX 310
Mailing Address - Street 2:
Mailing Address - City:GENOA
Mailing Address - State:NE
Mailing Address - Zip Code:68640-0310
Mailing Address - Country:US
Mailing Address - Phone:402-993-2283
Mailing Address - Fax:402-993-2373
Practice Address - Street 1:706 EWING ST
Practice Address - Street 2:
Practice Address - City:GENOA
Practice Address - State:NE
Practice Address - Zip Code:68640-3035
Practice Address - Country:US
Practice Address - Phone:402-993-2283
Practice Address - Fax:402-993-2373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-30
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEALF268310400000X
310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility