Basic Information
| Provider Information | |||||||||
| NPI: | 1548791353 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HERITAGE AT STERLING RIDGE OPERATING LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1111 STERLING RIDGE DR | ||||||||
| Address2: | |||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681441275 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4025043111 | ||||||||
| FaxNumber: | 4029330434 | ||||||||
| Practice Location | |||||||||
| Address1: | 1111 STERLING RIDGE DR | ||||||||
| Address2: | |||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681441275 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4025043111 | ||||||||
| FaxNumber: | 4029330434 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/23/2017 | ||||||||
| LastUpdateDate: | 03/23/2017 | ||||||||
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| AuthorizedOfficialLastName: | LICHTI | ||||||||
| AuthorizedOfficialFirstName: | TRACY | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 4025043111 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X | NE | Y | Nursing & Custodial Care Facilities | Assisted Living Facility |
No ID Information.