HILLCREST SHADOW LAKE, LLC
NPI 1245997436
Skilled Nursing Facility in Papillion, NE

Active since November 22, 2021CLIA 28D0453562 · Waiver
1507 E GOLD COAST RD, PAPILLION, NE 68046(402) 339-6010 Get Directions Write a Review

NPPES record last updated: November 22, 2021. Verified against the NPPES registry weekly; last sync: July 19, 2026.

About Hillcrest Shadow Lake, Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

HILLCREST SHADOW LAKE, LLC (NPI 1245997436), doing business as Hillcrest Shadow Lake, is a healthcare organization registered as a skilled nursing facility in Papillion, Nebraska and active in the NPI registry since November 2021. The organization holds a CLIA Waiver certificate valid through August 31, 2026 and lists Jolene L Mathison Roberts, President, as its authorized official.

NPPES Registry Identity

NPI1245997436
Entity TypeOrganization
Primary Taxonomy314000000X
Legal Business NameHILLCREST SHADOW LAKE, LLC
Location Address1507 E GOLD COAST RDPapillion, NE 68046-4722
Mailing Address1902 Harlan Dr Ste ABellevue, NE 68005-6609 · (402) 682-4201
Organization SubpartNo
Authorized OfficialJolene L Mathison RobertsPresident · (402) 682-4800
Enumeration DateNovember 22, 2021
NPPES CertifiedNovember 5, 2021
NPI 1245997436 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtySkilled Nursing FacilityNursing & Custodial Care Facilities
Taxonomy Code314000000X
Definition

(1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis.

1507 E GOLD COAST RD, Papillion, NE 68046

Other Names 1

Doing Business AsHillcrest Shadow Lake

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 28D0453562

Hillcrest Shadow Lake LLC Dba Hillcrest Shadow Lake · Papillion, NE
Active · expires Aug 31, 2026
CLIA Number28D0453562
Laboratory TypeSkilled Nursing Facility/Nursing Facility
Certificate Effective DateSeptember 1, 2024
Certificate Expiration DateAugust 31, 2026
Laboratory DirectorVickie Worden
Laboratory Phone(402) 682-4800
Laboratory LocationHillcrest Shadow Lake LLC Dba Hillcrest Shadow Lake1507 Gold Coast Rd, Papillion, NE 68046
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 5

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Physical Therapy Assistant
1507 E GOLD COAST RD
PAPILLION, NE 68046
Physical Therapist
1507 E GOLD COAST RD
PAPILLION, NE 68046
Skilled Nursing Facility
1507 E GOLD COAST RD
PAPILLION, NE 68046
Skilled Nursing Facility
1507 E GOLD COAST RD
PAPILLION, NE 68046
Occupational Therapist
1507 E GOLD COAST RD
PAPILLION, NE 68046

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Hillcrest Shadow Lake, LLC's NPI number?

The NPI number for Hillcrest Shadow Lake, LLC is 1245997436. It was assigned to this organization in the NPPES registry on November 22, 2021. The provider is doing business as Hillcrest Shadow Lake.

Where is Hillcrest Shadow Lake, LLC located?

Hillcrest Shadow Lake, LLC is located at 1507 E Gold Coast Rd, Papillion, NE 68046. The listed phone number is (402) 339-6010.

What is Hillcrest Shadow Lake, LLC's specialty?

The primary specialty registered for this NPI is Skilled Nursing Facility with taxonomy code 314000000X.

Does Hillcrest Shadow Lake, LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 28D0453562) is associated with this NPI, valid through August 31, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Hillcrest Shadow Lake, LLC was last updated on November 22, 2021. NPI Profile syncs with the weekly NPPES data releases published by CMS.