1689669756 NPI number — ELWOOD CARE CENTER

Table of content: (NPI 1689669756)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689669756 NPI number — ELWOOD CARE CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ELWOOD CARE CENTER
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:
Provider Other Organization Name Type Code:
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:
1689669756
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/09/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 315
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELWOOD
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68937-0315
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
308-785-3302
Provider Business Mailing Address Fax Number:
308-785-3193

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
607 SMITH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELWOOD
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68937-5236
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
308-785-3302
Provider Business Practice Location Address Fax Number:
308-785-3193
Provider Enumeration Date:
09/15/2005

Additional Information

Authorized Official

Authorized Official Last Name:
REINERS
Authorized Official First Name:
KATE
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
308-785-3302

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  354001 , 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: 276 . This is a "BC/BS PROVIDER NUMBER" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".




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