1285724229 NPI number — ELMS HEALTH CARE CENTER INC

Table of content: (NPI 1154320141)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285724229 NPI number — ELMS HEALTH CARE CENTER INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ELMS HEALTH CARE CENTER INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PONCA NURSING AND ASSISTED LIVING CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285724229
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/03/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
410 BALL PARK RD
Provider Second Line Business Mailing Address:
P O BOX 628
Provider Business Mailing Address City Name:
PONCA
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68770-7243
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-755-2233
Provider Business Mailing Address Fax Number:
402-755-2245

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
410 BALL PARK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PONCA
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68770-7243
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-755-2233
Provider Business Practice Location Address Fax Number:
402-755-2245
Provider Enumeration Date:
10/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HATCHER
Authorized Official First Name:
JACQUELINE
Authorized Official Middle Name:
R
Authorized Official Title or Position:
OWNER/ADMINISTRATOR
Authorized Official Telephone Number:
402-755-2233

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  244001 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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