Provider Demographics
NPI:1265497903
Name:WISNER CARE CENTER
Entity Type:Organization
Organization Name:WISNER CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LAVONNE
Authorized Official - Middle Name:R
Authorized Official - Last Name:HARROM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-529-3286
Mailing Address - Street 1:1105 9TH ST
Mailing Address - Street 2:
Mailing Address - City:WISNER
Mailing Address - State:NE
Mailing Address - Zip Code:68791-2113
Mailing Address - Country:US
Mailing Address - Phone:402-529-3286
Mailing Address - Fax:402-529-6560
Practice Address - Street 1:1105 9TH ST
Practice Address - Street 2:
Practice Address - City:WISNER
Practice Address - State:NE
Practice Address - Zip Code:68791-2113
Practice Address - Country:US
Practice Address - Phone:402-529-3286
Practice Address - Fax:402-529-6560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-18
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEALF197310400000X
NE184003314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE0322780001OtherDURABLE MEDICAL PROVIDER
NE=========00Medicaid
NE=========00Medicaid
NE285151Medicare ID - Type Unspecified