Provider Demographics
NPI:1639253651
Name:SENIOR CITIZENS FELLOWSHIP INC
Entity Type:Organization
Organization Name:SENIOR CITIZENS FELLOWSHIP INC
Other - Org Name:SUNSET HAVEN NURSING HOME HILLSIDE ESTATES ASSISTED LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROETHEMEYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-367-8388
Mailing Address - Street 1:RR1 BOX 401
Mailing Address - Street 2:
Mailing Address - City:CURTIS
Mailing Address - State:NE
Mailing Address - Zip Code:69025
Mailing Address - Country:US
Mailing Address - Phone:308-367-8388
Mailing Address - Fax:308-367-8387
Practice Address - Street 1:901 HOWARD AVE
Practice Address - Street 2:
Practice Address - City:CURTIS
Practice Address - State:NE
Practice Address - Zip Code:69025
Practice Address - Country:US
Practice Address - Phone:308-367-8388
Practice Address - Fax:308-367-8387
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEALF230310400000X
NE304001314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Not Answered314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========00Medicaid
NE285214Medicare ID - Type Unspecified