Provider Demographics
NPI:1588658009
Name:MILLER MEMORIAL CARE CENTER & ASSISTED LIVING
Entity Type:Organization
Organization Name:MILLER MEMORIAL CARE CENTER & ASSISTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LANA
Authorized Official - Middle Name:
Authorized Official - Last Name:BALKA
Authorized Official - Suffix:
Authorized Official - Credentials:LICENSE
Authorized Official - Phone:308-874-2292
Mailing Address - Street 1:P.O. BOX 428
Mailing Address - Street 2:
Mailing Address - City:CHAPPELL
Mailing Address - State:NE
Mailing Address - Zip Code:69129-0428
Mailing Address - Country:US
Mailing Address - Phone:308-874-2292
Mailing Address - Fax:308-874-2294
Practice Address - Street 1:589 VINCENT AVENUE
Practice Address - Street 2:
Practice Address - City:CHAPPELL
Practice Address - State:NE
Practice Address - Zip Code:69129
Practice Address - Country:US
Practice Address - Phone:308-874-2292
Practice Address - Fax:308-874-2294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-12
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE234001313M00000X
NEALF052313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility