Provider Demographics
NPI:1417198367
Name:JEFFERSON COMMUNITY HEALTH CENTER, INC
Entity Type:Organization
Organization Name:JEFFERSON COMMUNITY HEALTH CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:E
Authorized Official - Last Name:JURGENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-729-3351
Mailing Address - Street 1:2200 H ST
Mailing Address - Street 2:
Mailing Address - City:FAIRBURY
Mailing Address - State:NE
Mailing Address - Zip Code:68352-1119
Mailing Address - Country:US
Mailing Address - Phone:402-729-3351
Mailing Address - Fax:402-729-2102
Practice Address - Street 1:2200 H ST
Practice Address - Street 2:
Practice Address - City:FAIRBURY
Practice Address - State:NE
Practice Address - Zip Code:68352-1119
Practice Address - Country:US
Practice Address - Phone:402-729-3351
Practice Address - Fax:402-729-2102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-23
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NELTCH010314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE285282Medicare Oscar/Certification