Provider Demographics
NPI:1447385588
Name:COVENANT CARE MIDWEST, INC
Entity Type:Organization
Organization Name:COVENANT CARE MIDWEST, INC
Other - Org Name:NEBRASKA SKILLED NURSING AND REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF REIMBURSMENT
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:SPARKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-349-1200
Mailing Address - Street 1:7410 MERCY RD
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-2317
Mailing Address - Country:US
Mailing Address - Phone:402-397-1220
Mailing Address - Fax:402-397-4102
Practice Address - Street 1:7410 MERCY RD
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-2317
Practice Address - Country:US
Practice Address - Phone:402-397-1220
Practice Address - Fax:402-397-4102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE264002314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
28-5058Medicare ID - Type Unspecified