Provider Demographics
NPI:1760521926
Name:VILLAGE OF CAMPBELL
Entity Type:Organization
Organization Name:VILLAGE OF CAMPBELL
Other - Org Name:GRANDVIEW MANOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VILLAGE CHAIRMAN
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:SKUPA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-756-8661
Mailing Address - Street 1:148 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:NE
Mailing Address - Zip Code:68932-2610
Mailing Address - Country:US
Mailing Address - Phone:402-756-8701
Mailing Address - Fax:402-756-8705
Practice Address - Street 1:148 BROAD ST
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:NE
Practice Address - Zip Code:68932-2610
Practice Address - Country:US
Practice Address - Phone:402-756-8701
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE294001314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE000811OtherBLUE CROSS
NE000811OtherBLUE CROSS
NE=========Medicaid
285155Medicare Oscar/Certification