Basic Information
| Provider Information | |||||||||
| NPI: | 1558857508 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | LEXINGTON OPERATIONS, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | AVAMERE AT LEXINGTON | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1811 RIDGEWAY DR | ||||||||
| Address2: | |||||||||
| City: | LEXINGTON | ||||||||
| State: | NE | ||||||||
| PostalCode: | 688501188 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3083245490 | ||||||||
| FaxNumber: | 3083245181 | ||||||||
| Practice Location | |||||||||
| Address1: | 1811 RIDGEWAY DR | ||||||||
| Address2: | |||||||||
| City: | LEXINGTON | ||||||||
| State: | NE | ||||||||
| PostalCode: | 688501188 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3083245490 | ||||||||
| FaxNumber: | 3083245181 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/02/2018 | ||||||||
| LastUpdateDate: | 07/02/2018 | ||||||||
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| AuthorizedOfficialLastName: | OLSON | ||||||||
| AuthorizedOfficialFirstName: | CHRIS | ||||||||
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| AuthorizedOfficialTitleorPosition: | PARALEGAL | ||||||||
| AuthorizedOfficialTelephone: | 5037832490 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X | ALF125 | NE | Y | Nursing & Custodial Care Facilities | Assisted Living Facility |
No ID Information.