Provider Demographics
NPI:1972896611
Name:MERIDIAN GARDENSOPERATING LLC
Entity type:Organization
Organization Name:MERIDIAN GARDENSOPERATING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:ZEHR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-564-6300
Mailing Address - Street 1:4515 38TH ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:NE
Mailing Address - Zip Code:68601-1609
Mailing Address - Country:US
Mailing Address - Phone:402-564-6300
Mailing Address - Fax:402-562-4594
Practice Address - Street 1:4515 38TH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:NE
Practice Address - Zip Code:68601-1609
Practice Address - Country:US
Practice Address - Phone:402-564-6300
Practice Address - Fax:402-562-4594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-26
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE100254514/00Medicaid