Provider Demographics
NPI:1609580554
Name:THE NEBRASKA MASONIC HOME
Entity Type:Organization
Organization Name:THE NEBRASKA MASONIC HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:APRIL
Authorized Official - Middle Name:L
Authorized Official - Last Name:JOHNSTON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:402-293-7303
Mailing Address - Street 1:1300 AVENUE D
Mailing Address - Street 2:
Mailing Address - City:PLATTSMOUTH
Mailing Address - State:NE
Mailing Address - Zip Code:68048-1055
Mailing Address - Country:US
Mailing Address - Phone:402-296-7324
Mailing Address - Fax:402-296-3855
Practice Address - Street 1:1300 AVENUE D
Practice Address - Street 2:
Practice Address - City:PLATTSMOUTH
Practice Address - State:NE
Practice Address - Zip Code:68048-1055
Practice Address - Country:US
Practice Address - Phone:402-296-7324
Practice Address - Fax:402-296-3855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-05
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SL0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistLong-Term CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE364SLO600XOtherLONG TERM CONTINUING CARE FACILITY