Provider Demographics
NPI:1508159591
Name:SHALIMAR GARDENS ASSISTED LIVING
Entity Type:Organization
Organization Name:SHALIMAR GARDENS ASSISTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:INA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARROLL
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:402-721-1616
Mailing Address - Street 1:749 E 29TH ST
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:NE
Mailing Address - Zip Code:68025-7711
Mailing Address - Country:US
Mailing Address - Phone:402-721-1616
Mailing Address - Fax:402-753-8080
Practice Address - Street 1:749 E 29TH ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:NE
Practice Address - Zip Code:68025-7711
Practice Address - Country:US
Practice Address - Phone:402-721-1616
Practice Address - Fax:402-753-8080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-24
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEALF257310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE100252898-00Medicaid