Provider Demographics
NPI:1558368050
Name:CELEBRATE LIFE, INC.
Entity Type:Organization
Organization Name:CELEBRATE LIFE, INC.
Other - Org Name:BIRCHWOOD MANOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-652-3242
Mailing Address - Street 1:1120 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:NORTH BEND
Mailing Address - State:NE
Mailing Address - Zip Code:68649-5012
Mailing Address - Country:US
Mailing Address - Phone:402-652-3242
Mailing Address - Fax:402-652-3547
Practice Address - Street 1:1120 WALNUT ST
Practice Address - Street 2:
Practice Address - City:NORTH BEND
Practice Address - State:NE
Practice Address - Zip Code:68649-5012
Practice Address - Country:US
Practice Address - Phone:402-652-3242
Practice Address - Fax:402-652-3547
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE254005314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE60003OtherBCBS OF NEBRASKA
NE10024947400Medicaid
NE285247Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER