Provider Demographics
NPI:1629565452
Name:COMPASSIONATE MEMORY CARE 2, INC
Entity Type:Organization
Organization Name:COMPASSIONATE MEMORY CARE 2, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-650-5089
Mailing Address - Street 1:14805 DAYTON ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68137-5373
Mailing Address - Country:US
Mailing Address - Phone:402-650-5089
Mailing Address - Fax:
Practice Address - Street 1:407 S 86TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-4250
Practice Address - Country:US
Practice Address - Phone:402-614-7446
Practice Address - Fax:402-614-7960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-17
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEALF330311500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)