Provider Demographics
NPI:1043291453
Name:MOTHER HULL HOME
Entity Type:Organization
Organization Name:MOTHER HULL HOME
Other - Org Name:MOTHER HULL HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-234-2447
Mailing Address - Street 1:125 E 23RD STREET
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68847-5425
Mailing Address - Country:US
Mailing Address - Phone:308-234-2447
Mailing Address - Fax:308-234-6823
Practice Address - Street 1:125 E 23RD STREET
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68847-5425
Practice Address - Country:US
Practice Address - Phone:308-234-2447
Practice Address - Fax:308-234-6823
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-11
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE074002314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE074002OtherSTATE LICENSE
NE074002OtherSTATE LICENSE
NE074002OtherSTATE LICENSE
NE285254Medicare Oscar/Certification