Provider Demographics
NPI:1043404718
Name:BROOKESTONE MEADOWS INC
Entity Type:Organization
Organization Name:BROOKESTONE MEADOWS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:VETTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-289-2696
Mailing Address - Street 1:600 BROOKESTONE MEADOWS PLAZA
Mailing Address - Street 2:
Mailing Address - City:ELKHORN
Mailing Address - State:NE
Mailing Address - Zip Code:68022-4401
Mailing Address - Country:US
Mailing Address - Phone:402-289-2696
Mailing Address - Fax:402-289-1090
Practice Address - Street 1:600 BROOKESTONE MEADOWS PLAZA
Practice Address - Street 2:
Practice Address - City:ELKHORN
Practice Address - State:NE
Practice Address - Zip Code:68022-4401
Practice Address - Country:US
Practice Address - Phone:402-289-2696
Practice Address - Fax:402-289-1090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-05
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NENH006314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NENH006OtherSTATE LICENSE NUMBER
NENH006OtherSTATE LICENSE NUMBER
NE1324330001Medicare NSC