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COUNTRYSIDE VILLA
NPI 1477627677
Assisted Living Facility in Wausa, NE

Active since November 20, 2006CLIA 28D2195514 · Waiver
803 S VIVIAN ST, WAUSA, NE 68786(402) 586-2890(402) 586-2945 Get Directions Write a Review

NPPES record last updated: August 22, 2020. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Countryside Villa NPPES

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

COUNTRYSIDE VILLA (NPI 1477627677) is a healthcare organization registered as an assisted living facility in Wausa, Nebraska and active in the NPI registry since November 2006. The organization holds a CLIA Waiver certificate valid through October 8, 2026 and lists Jean M Holcomb, Administrator, as its authorized official.

NPPES Registry Identity

NPI1477627677
Entity TypeOrganization
Primary Taxonomy310400000X
Legal Business NameWAUSA LEISURE LIVING, LLC
Location Address803 S VIVIAN STWausa, NE 68786-2046
Mailing Address803 S Vivian StWausa, NE 68786-2046 · (402) 586-2890 · Fax (402) 586-2945
Phone(402) 586-2890
Fax(402) 586-2945
Organization SubpartNo
Authorized OfficialJean M HolcombAdministrator · (402) 586-2890
Enumeration DateNovember 20, 2006
Last NPPES UpdateAugust 22, 2020
✔ NPI 1477627677 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyAssisted Living FacilityNursing & Custodial Care Facilities
Taxonomy Code310400000X
License✔ Licensed in NE · ALF232
Definition
A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being.
803 S VIVIAN ST, Wausa, NE 68786
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Other Names 1

Doing Business AsCountryside Villa

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 28D2195514

Countryside Villa · Wausa, NE
Active · expires Oct 8, 2026
CLIA Number28D2195514
Laboratory TypeAssisted Living Facility
Certificate Effective DateOctober 9, 2024
Certificate Expiration DateOctober 8, 2026
Laboratory DirectorLeigh E. Bloomquist
Laboratory Phone(402) 586-2890
Laboratory LocationCountryside Villa808 S Vivian, Wausa, NE 68786
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

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 Wausa Leisure Living, LLC's NPI number?

The NPI number for Wausa Leisure Living, LLC is 1477627677. It was assigned to this organization in the NPPES registry on November 20, 2006. The provider is doing business as Countryside Villa.

Where is Wausa Leisure Living, LLC located?

Wausa Leisure Living, LLC is located at 803 S Vivian St, Wausa, NE 68786. The listed phone number is (402) 586-2890.

What is Wausa Leisure Living, LLC's specialty?

The primary specialty registered for this NPI is Assisted Living Facility with taxonomy code 310400000X.

Does Wausa Leisure Living, LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 28D2195514) is associated with this NPI, valid through October 8, 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 Wausa Leisure Living, LLC was last updated on August 22, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.