Provider Demographics
NPI:1730472929
Name:GRAND LIVING ALTERNATIVES
Entity Type:Organization
Organization Name:GRAND LIVING ALTERNATIVES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGEMENT COMPANY
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:NIELSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-730-0715
Mailing Address - Street 1:827 N 19TH ST
Mailing Address - Street 2:
Mailing Address - City:ORD
Mailing Address - State:NE
Mailing Address - Zip Code:68862-1084
Mailing Address - Country:US
Mailing Address - Phone:308-728-3967
Mailing Address - Fax:308-728-7958
Practice Address - Street 1:827 N 19TH ST
Practice Address - Street 2:
Practice Address - City:ORD
Practice Address - State:NE
Practice Address - Zip Code:68862-1084
Practice Address - Country:US
Practice Address - Phone:308-728-3967
Practice Address - Fax:308-728-7958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-19
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEALF213310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility