Provider Demographics
NPI:1235132184
Name:HOLDREGE MEMORIAL HOMES, INC.
Entity Type:Organization
Organization Name:HOLDREGE MEMORIAL HOMES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MORIARTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-995-8631
Mailing Address - Street 1:1320 11TH AVE
Mailing Address - Street 2:
Mailing Address - City:HOLDREGE
Mailing Address - State:NE
Mailing Address - Zip Code:68949-1919
Mailing Address - Country:US
Mailing Address - Phone:308-995-8631
Mailing Address - Fax:308-995-8636
Practice Address - Street 1:1320 11TH AVE
Practice Address - Street 2:
Practice Address - City:HOLDREGE
Practice Address - State:NE
Practice Address - Zip Code:68949-1919
Practice Address - Country:US
Practice Address - Phone:308-995-8631
Practice Address - Fax:308-995-8636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-24
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEALF110310400000X
NE614003314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========-00Medicaid
NE=========-11Medicaid
285067Medicare Oscar/Certification
NE0641010001Medicare NSC