Provider Demographics
NPI:1548791353
Name:HERITAGE AT STERLING RIDGE OPERATING LLC
Entity Type:Organization
Organization Name:HERITAGE AT STERLING RIDGE OPERATING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:LICHTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-504-3111
Mailing Address - Street 1:1111 STERLING RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-1275
Mailing Address - Country:US
Mailing Address - Phone:402-504-3111
Mailing Address - Fax:402-933-0434
Practice Address - Street 1:1111 STERLING RIDGE DR
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-1275
Practice Address - Country:US
Practice Address - Phone:402-504-3111
Practice Address - Fax:402-933-0434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-23
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility