Provider Demographics
NPI:1508419789
Name:SPRING CREEK HOME, LLC.
Entity Type:Organization
Organization Name:SPRING CREEK HOME, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CASEY
Authorized Official - Middle Name:JO
Authorized Official - Last Name:SNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-746-3267
Mailing Address - Street 1:602 MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:INAVALE
Mailing Address - State:NE
Mailing Address - Zip Code:68952-8000
Mailing Address - Country:US
Mailing Address - Phone:402-746-3267
Mailing Address - Fax:
Practice Address - Street 1:602 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:INAVALE
Practice Address - State:NE
Practice Address - Zip Code:68952-8000
Practice Address - Country:US
Practice Address - Phone:402-746-3267
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-17
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026005100Medicaid