Provider Demographics
NPI:1407137409
Name:REGIONAL WEST VILLAGE
Entity Type:Organization
Organization Name:REGIONAL WEST VILLAGE
Other - Org Name:THE VILLAGE AT REGIONAL WEST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIFFITHS
Authorized Official - Suffix:
Authorized Official - Credentials:CFO
Authorized Official - Phone:308-630-1111
Mailing Address - Street 1:320 E 42ND ST.
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBLUFF
Mailing Address - State:NE
Mailing Address - Zip Code:69361-4788
Mailing Address - Country:US
Mailing Address - Phone:308-630-2001
Mailing Address - Fax:308-630-2006
Practice Address - Street 1:320 E 42ND ST
Practice Address - Street 2:
Practice Address - City:SCOTTSBLUFF
Practice Address - State:NE
Practice Address - Zip Code:69361-4788
Practice Address - Country:US
Practice Address - Phone:308-630-2001
Practice Address - Fax:308-630-2006
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REGIONAL WEST HEALTH SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-09-02
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEALF146310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE100256614-00Medicaid