Provider Demographics
NPI:1992179675
Name:SL WAHOO, LLC
Entity Type:Organization
Organization Name:SL WAHOO, LLC
Other - Org Name:SAUNDERS HOUSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAMIEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-443-3333
Mailing Address - Street 1:1313 N HACKBERRY ST
Mailing Address - Street 2:
Mailing Address - City:WAHOO
Mailing Address - State:NE
Mailing Address - Zip Code:68066-1148
Mailing Address - Country:US
Mailing Address - Phone:402-443-3333
Mailing Address - Fax:402-443-5578
Practice Address - Street 1:1313 N HACKBERRY ST
Practice Address - Street 2:
Practice Address - City:WAHOO
Practice Address - State:NE
Practice Address - Zip Code:68066-1148
Practice Address - Country:US
Practice Address - Phone:402-443-3333
Practice Address - Fax:402-443-5578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-18
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEALF152310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility