Provider Demographics
NPI:1215012802
Name:LITZENBERG MEMORIAL MERRICK COUNTY
Entity Type:Organization
Organization Name:LITZENBERG MEMORIAL MERRICK COUNTY
Other - Org Name:LITZENBERG MEMORIAL COUNTY HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:MARGARET
Authorized Official - Last Name:TRIPLETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-946-2920
Mailing Address - Street 1:1715 26TH ST
Mailing Address - Street 2:
Mailing Address - City:CENTRAL CITY
Mailing Address - State:NE
Mailing Address - Zip Code:68826-9501
Mailing Address - Country:US
Mailing Address - Phone:308-946-3015
Mailing Address - Fax:308-946-5914
Practice Address - Street 1:1715 26TH ST
Practice Address - Street 2:
Practice Address - City:CENTRAL CITY
Practice Address - State:NE
Practice Address - Zip Code:68826-9501
Practice Address - Country:US
Practice Address - Phone:308-946-2920
Practice Address - Fax:308-946-3774
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LITZENBERG MEMORIAL MERRICK COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-25
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251J00000X
NELTCH006313M00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No251J00000XAgenciesNursing Care
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE1215012802Medicaid