Provider Demographics
NPI:1376693010
Name:CROWELL MEMORIAL HOME
Entity Type:Organization
Organization Name:CROWELL MEMORIAL HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BILL
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-426-2177
Mailing Address - Street 1:245 S 22ND ST
Mailing Address - Street 2:
Mailing Address - City:BLAIR
Mailing Address - State:NE
Mailing Address - Zip Code:68008-1811
Mailing Address - Country:US
Mailing Address - Phone:402-426-2177
Mailing Address - Fax:402-426-2577
Practice Address - Street 1:245 S 22ND ST
Practice Address - Street 2:
Practice Address - City:BLAIR
Practice Address - State:NE
Practice Address - Zip Code:68008-1811
Practice Address - Country:US
Practice Address - Phone:402-426-2177
Practice Address - Fax:402-426-2577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEALF049310400000X
NE794001314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========00Medicaid
NE285210Medicare Oscar/Certification