Provider Demographics
NPI:1326039595
Name:SARAH ANN HESTER MEMORIAL HOME
Entity Type:Organization
Organization Name:SARAH ANN HESTER MEMORIAL HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:PROVISIONAL NHA
Authorized Official - Phone:308-423-2179
Mailing Address - Street 1:407 DAKOTA STREET
Mailing Address - Street 2:P.O. BOX 646
Mailing Address - City:BENKELMAN
Mailing Address - State:NE
Mailing Address - Zip Code:69021
Mailing Address - Country:US
Mailing Address - Phone:308-423-2179
Mailing Address - Fax:308-423-2107
Practice Address - Street 1:407 DAKOTA STREET
Practice Address - Street 2:
Practice Address - City:BENKELMAN
Practice Address - State:NE
Practice Address - Zip Code:69021
Practice Address - Country:US
Practice Address - Phone:308-423-2179
Practice Address - Fax:308-423-2107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-04
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEALF151310400000X
NE274001314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE285241Medicare Oscar/Certification
NE4033570001Medicare NSC