28D1026438 CLIA NUMBER - GRANVILLE VILLA ASSISTED LIVING

Laboratory Demographics

CLIA Number: 28D1026438

Facility Name: GRANVILLE VILLA ASSISTED LIVING

Facility Address:
8507 GRANVILLE PKWY
LAVISTA, NE
ZIP 68128
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Facility Phone Number: 402 933-6405

Facility Type: Assisted Living Facility

Certificate Type: Waiver

NPI Number: 1730385709

Taxonomy: 305S00000X - Point of Service
This product may also be called an open-ended HMO and offers a transition product incorporating features of both HMOs and PPOs. Beneficiaries are enrolled in an HMO but have the option to go outside the networks for an additional cost.

CLIA Record

Field Name	Field Value
CLIA Number	28D1026438
LAB Type	Assisted Living Facility
Facility Name	GRANVILLE VILLA ASSISTED LIVING
Street	8507 GRANVILLE PKWY
City	LAVISTA
State	NE
ZIP	68128
Phone	402 933-6405
CertificateType	4
CertificateEffectiveDate	6/4/2022
CertificateExpirationDate	6/3/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024