Provider Demographics
NPI:1003807942
Name:MID-NEBRASKA LUTHERAN HOME, ASSN.
Entity Type:Organization
Organization Name:MID-NEBRASKA LUTHERAN HOME, ASSN.
Other - Org Name:MID-NEBRASKA LUTHERAN HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDSI
Authorized Official - Middle Name:
Authorized Official - Last Name:LUEKEN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:402-447-6203
Mailing Address - Street 1:PO BOX 459
Mailing Address - Street 2:109 NORTH 2ND STREET
Mailing Address - City:NEWMAN GROVE
Mailing Address - State:NE
Mailing Address - Zip Code:68758-0459
Mailing Address - Country:US
Mailing Address - Phone:402-447-6203
Mailing Address - Fax:402-447-6244
Practice Address - Street 1:109 N 2ND ST
Practice Address - Street 2:
Practice Address - City:NEWMAN GROVE
Practice Address - State:NE
Practice Address - Zip Code:68758-6017
Practice Address - Country:US
Practice Address - Phone:402-447-6203
Practice Address - Fax:402-447-6363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-31
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE524003314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025268700OtherSPEECH PROVIDER
NE28E109Medicaid
NE28E109Medicaid
NE285213Medicare Oscar/Certification