Provider Demographics
NPI:1275591588
Name:KIMBALL COUNTY MANOR
Entity Type:Organization
Organization Name:KIMBALL COUNTY MANOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-235-4693
Mailing Address - Street 1:810 E 7TH ST
Mailing Address - Street 2:
Mailing Address - City:KIMBALL
Mailing Address - State:NE
Mailing Address - Zip Code:69145-1615
Mailing Address - Country:US
Mailing Address - Phone:308-235-4693
Mailing Address - Fax:308-235-2082
Practice Address - Street 1:810 E 7TH ST
Practice Address - Street 2:
Practice Address - City:KIMBALL
Practice Address - State:NE
Practice Address - Zip Code:69145-1615
Practice Address - Country:US
Practice Address - Phone:308-235-4693
Practice Address - Fax:308-235-2082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE484001314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========Medicaid
NE=========Medicaid