Provider Demographics
NPI:1326047697
Name:MIDWEST COVENANT HOME, INC.
Entity Type:Organization
Organization Name:MIDWEST COVENANT HOME, INC.
Other - Org Name:MIDWEST COVENANT HOME, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:M
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-764-2711
Mailing Address - Street 1:615 E 9TH ST
Mailing Address - Street 2:PO BOX 367
Mailing Address - City:STROMSBURG
Mailing Address - State:NE
Mailing Address - Zip Code:68666-4053
Mailing Address - Country:US
Mailing Address - Phone:402-764-2711
Mailing Address - Fax:402-764-4352
Practice Address - Street 1:615 E 9TH ST
Practice Address - Street 2:
Practice Address - City:STROMSBURG
Practice Address - State:NE
Practice Address - Zip Code:68666-4053
Practice Address - Country:US
Practice Address - Phone:402-764-2711
Practice Address - Fax:402-764-4352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-19
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE644002314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
F249543OtherAETNA
F249543OtherCIGNA
00526OtherBLUE CROSS BLUE SHIELD
0640750001OtherDMERC
F249543OtherTEAMCARE
F249543OtherMIDLANDS CHOICE
F249543OtherMIDLANDS CHOICE
=========OtherUNICARE
=========OtherHUMANA
=========OtherUNICARE