Provider Demographics
NPI:1073577680
Name:MOUNT CARMEL HOME KEENS MEMORIAL
Entity Type:Organization
Organization Name:MOUNT CARMEL HOME KEENS MEMORIAL
Other - Org Name:MT CARMEL HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:BANDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-237-2287
Mailing Address - Street 1:412 W 18TH ST
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68845-5948
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:412 W 18TH ST
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68845-5948
Practice Address - Country:US
Practice Address - Phone:308-237-2287
Practice Address - Fax:308-237-7264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-12
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE074003314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE00661OtherBLUE CROSS BLUE SHIELD
NE=========00Medicaid
NE285216Medicare Oscar/Certification