1003807942 NPI number — MID-NEBRASKA LUTHERAN HOME, ASSN.

Table of content: (NPI 1003807942)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003807942 NPI number — MID-NEBRASKA LUTHERAN HOME, ASSN.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MID-NEBRASKA LUTHERAN HOME, ASSN.
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:
MID-NEBRASKA LUTHERAN HOME
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:
1003807942
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/16/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 459
Provider Second Line Business Mailing Address:
109 NORTH 2ND STREET
Provider Business Mailing Address City Name:
NEWMAN GROVE
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68758-0459
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-447-6203
Provider Business Mailing Address Fax Number:
402-447-6244

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
109 N 2ND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWMAN GROVE
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68758-6017
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-447-6203
Provider Business Practice Location Address Fax Number:
402-447-6363
Provider Enumeration Date:
10/31/2005

Additional Information

Authorized Official

Authorized Official Last Name:
LUEKEN
Authorized Official First Name:
LINDSI
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
402-447-6203

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  524003 , 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)

  • Identifier: 10025268700 . This is a "SPEECH PROVIDER" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 28E109 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".




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