Provider Demographics
NPI:1336134246
Name:NORTHFIELD RETIREMENT COMMUNITIES
Entity Type:Organization
Organization Name:NORTHFIELD RETIREMENT COMMUNITIES
Other - Org Name:NORTHFIELD VILLA HEALTHCARE CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DARRELL
Authorized Official - Middle Name:E
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-630-8199
Mailing Address - Street 1:2100 CIRCLE DRIVE
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBLUFF
Mailing Address - State:NE
Mailing Address - Zip Code:69363-1894
Mailing Address - Country:US
Mailing Address - Phone:308-630-8291
Mailing Address - Fax:308-630-8190
Practice Address - Street 1:2550 21ST STREET
Practice Address - Street 2:
Practice Address - City:GERING
Practice Address - State:NE
Practice Address - Zip Code:69341
Practice Address - Country:US
Practice Address - Phone:308-436-3101
Practice Address - Fax:308-436-3493
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHFIELD RETIREMENT COMMUNITIES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-09-16
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE704002314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========00Medicaid
285194Medicare UPIN