Provider Demographics
NPI:1154702611
Name:KINGSWOOD COURT ASSISTED LIVING, LLC
Entity type:Organization
Organization Name:KINGSWOOD COURT ASSISTED LIVING, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SORSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-759-6208
Mailing Address - Street 1:1005 IDAHO ST
Mailing Address - Street 2:
Mailing Address - City:SUPERIOR
Mailing Address - State:NE
Mailing Address - Zip Code:68978-1103
Mailing Address - Country:US
Mailing Address - Phone:402-207-1050
Mailing Address - Fax:402-207-1052
Practice Address - Street 1:1005 IDAHO ST
Practice Address - Street 2:
Practice Address - City:SUPERIOR
Practice Address - State:NE
Practice Address - Zip Code:68978-1103
Practice Address - Country:US
Practice Address - Phone:402-207-1050
Practice Address - Fax:402-207-1052
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CARING FRIENDS IN HOME CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-06-10
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
253Z00000X
NEALF353310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility