Provider Demographics
NPI:1477077808
Name:LINCOLN COUNTRYHOUSE III, LLC
Entity Type:Organization
Organization Name:LINCOLN COUNTRYHOUSE III, LLC
Other - Org Name:COUNTRYHOUSE RESIDENCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SUZY
Authorized Official - Middle Name:JESSICA
Authorized Official - Last Name:NOOTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-421-2200
Mailing Address - Street 1:240 S 70TH ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-2406
Mailing Address - Country:US
Mailing Address - Phone:402-421-2200
Mailing Address - Fax:531-289-1494
Practice Address - Street 1:240 S 70TH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-2406
Practice Address - Country:US
Practice Address - Phone:402-421-2200
Practice Address - Fax:531-289-1494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEALF369251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care