Provider Demographics
NPI:1215413315
Name:MAGGIE ANN'S SKILLED NURSING & RESPITE CARE, LLC
Entity Type:Organization
Organization Name:MAGGIE ANN'S SKILLED NURSING & RESPITE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:PHELPS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:402-216-9636
Mailing Address - Street 1:10813 S 109TH ST
Mailing Address - Street 2:
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68046-5534
Mailing Address - Country:US
Mailing Address - Phone:402-968-0812
Mailing Address - Fax:
Practice Address - Street 1:10813 S 109TH ST
Practice Address - Street 2:
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68046-5534
Practice Address - Country:US
Practice Address - Phone:402-968-0812
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-12
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health