Provider Demographics
NPI:1437134004
Name:CITY OF FAIRMONT NEBRASKA - FAIRVIEW MANOR
Entity Type:Organization
Organization Name:CITY OF FAIRMONT NEBRASKA - FAIRVIEW MANOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHEIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:400-226-8227
Mailing Address - Street 1:255 F ST
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:NE
Mailing Address - Zip Code:68354-9771
Mailing Address - Country:US
Mailing Address - Phone:402-268-2271
Mailing Address - Fax:402-268-3901
Practice Address - Street 1:255 F ST
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:NE
Practice Address - Zip Code:68354-9771
Practice Address - Country:US
Practice Address - Phone:402-268-2271
Practice Address - Fax:402-268-3901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-07
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE284002314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47600618600Medicaid
NE47600618600Medicaid