Provider Demographics
NPI:1245604024
Name:SL NORFOLK, LLC
Entity type:Organization
Organization Name:SL NORFOLK, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOCELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:BORUCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-644-4567
Mailing Address - Street 1:1120 N 1ST ST
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-0904
Mailing Address - Country:US
Mailing Address - Phone:402-644-4567
Mailing Address - Fax:402-644-8111
Practice Address - Street 1:1120 N 1ST ST
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-0904
Practice Address - Country:US
Practice Address - Phone:402-644-4567
Practice Address - Fax:402-644-8111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-17
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEALF103310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility