Provider Demographics
NPI:1598968372
Name:PAWNEE ASSISTED LIVING
Entity Type:Organization
Organization Name:PAWNEE ASSISTED LIVING
Other - Org Name:HOTEL PAWNEE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:J
Authorized Official - Last Name:SCHADE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-532-6600
Mailing Address - Street 1:221 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69101-6918
Mailing Address - Country:US
Mailing Address - Phone:308-532-6600
Mailing Address - Fax:308-532-9644
Practice Address - Street 1:221 E 5TH ST
Practice Address - Street 2:
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-6918
Practice Address - Country:US
Practice Address - Phone:308-532-6600
Practice Address - Fax:308-532-9644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2011-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE515005310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE100000117Medicaid