Provider Demographics
NPI:1033292594
Name:ANTELOPE MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:ANTELOPE MEMORIAL HOSPITAL
Other - Org Name:ANTELOPE MEMORIAL HOSPITAL HOME HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:M
Authorized Official - Last Name:BRUGGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-887-4151
Mailing Address - Street 1:PO BOX 229
Mailing Address - Street 2:
Mailing Address - City:NELIGH
Mailing Address - State:NE
Mailing Address - Zip Code:68756-0229
Mailing Address - Country:US
Mailing Address - Phone:402-887-4151
Mailing Address - Fax:402-887-4092
Practice Address - Street 1:102 W 9TH ST
Practice Address - Street 2:
Practice Address - City:NELIGH
Practice Address - State:NE
Practice Address - Zip Code:68756-1114
Practice Address - Country:US
Practice Address - Phone:402-887-4151
Practice Address - Fax:402-887-4092
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANTELOPE MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-20
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE021001251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE287040Medicare Oscar/Certification