Provider Demographics
NPI:1659412047
Name:BERTRAND NURSING HOME
Entity Type:Organization
Organization Name:BERTRAND NURSING HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:A
Authorized Official - Last Name:HOFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:308-472-3341
Mailing Address - Street 1:PO BOX 97
Mailing Address - Street 2:100 MINOR AVENUE
Mailing Address - City:BERTRAND
Mailing Address - State:NE
Mailing Address - Zip Code:68927-0097
Mailing Address - Country:US
Mailing Address - Phone:308-472-3341
Mailing Address - Fax:308-472-3284
Practice Address - Street 1:100 MINOR AVE
Practice Address - Street 2:
Practice Address - City:BERTRAND
Practice Address - State:NE
Practice Address - Zip Code:68927-9546
Practice Address - Country:US
Practice Address - Phone:308-472-3341
Practice Address - Fax:308-472-3284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2012-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEALF009310400000X
NE614001314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE5341340001OtherMEICARE DMERC
NE00741OtherBLUE CROSS BLUE SHIELD
NEALF009Medicaid
NE10025441400OtherHOSPICE
NE5341340001OtherMEICARE DMERC
NE00741OtherBLUE CROSS BLUE SHIELD