1689712952 NPI number — CITY OF MITCHELL

Table of content: (NPI 1689712952)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689712952 NPI number — CITY OF MITCHELL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF MITCHELL
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:
MITCHELL CARE 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:
1689712952
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/25/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1723 23RD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MITCHELL
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
69357-1000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
308-623-1212
Provider Business Mailing Address Fax Number:
308-623-2052

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1723 23RD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MITCHELL
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
69357
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
308-623-1212
Provider Business Practice Location Address Fax Number:
308-623-2052
Provider Enumeration Date:
02/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HAHN
Authorized Official First Name:
STEPHANIE
Authorized Official Middle Name:
JUNE
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
308-623-1212

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , with the licence number:  ALF266 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 314000000X , with the licence number: 704003 , 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: 28E246 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".




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