Provider Demographics
NPI:1245215342
Name:CITY OF FAIRMONT NEBRASKA - FAIRVIEW MANOR DBA COUNTRY REFLECTIONS
Entity Type:Organization
Organization Name:CITY OF FAIRMONT NEBRASKA - FAIRVIEW MANOR DBA COUNTRY REFLECTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHEIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-268-2271
Mailing Address - Street 1:255 F ST
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:NE
Mailing Address - Zip Code:68354-9771
Mailing Address - Country:US
Mailing Address - Phone:402-268-2271
Mailing Address - Fax:402-268-3901
Practice Address - Street 1:255 F ST
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:NE
Practice Address - Zip Code:68354-9771
Practice Address - Country:US
Practice Address - Phone:402-268-2271
Practice Address - Fax:402-268-3901
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CITY OF FAIRMONT NEBRASKA - FAIRVIEW MANOR
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-12-12
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEALF264310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========00Medicaid