Provider Demographics
NPI:1609650092
Name:WESTERN AVENUE SENIOR LIVING OP CO, LLC
Entity Type:Organization
Organization Name:WESTERN AVENUE SENIOR LIVING OP CO, LLC
Other - Org Name:ASTORIA SENIOR LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARTIN (MARTY)
Authorized Official - Middle Name:L
Authorized Official - Last Name:HUG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-469-0750
Mailing Address - Street 1:9220 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-2297
Mailing Address - Country:US
Mailing Address - Phone:402-393-7313
Mailing Address - Fax:
Practice Address - Street 1:9220 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-2297
Practice Address - Country:US
Practice Address - Phone:402-393-7313
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AGEMARK MANAGEMENT. LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-08-24
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility