Provider Demographics
NPI:1235429903
Name:NEBRASKA P.E.O. HOME
Entity Type:Organization
Organization Name:NEBRASKA P.E.O. HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:A
Authorized Official - Last Name:MAGILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-228-4208
Mailing Address - Street 1:413 N 5TH ST
Mailing Address - Street 2:
Mailing Address - City:BEATRICE
Mailing Address - State:NE
Mailing Address - Zip Code:68310-2902
Mailing Address - Country:US
Mailing Address - Phone:402-228-4208
Mailing Address - Fax:402-228-4209
Practice Address - Street 1:413 N 5TH ST
Practice Address - Street 2:
Practice Address - City:BEATRICE
Practice Address - State:NE
Practice Address - Zip Code:68310-2902
Practice Address - Country:US
Practice Address - Phone:402-228-4208
Practice Address - Fax:402-228-4209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-14
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEALF287310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE100254577-00Medicaid