Provider Demographics
NPI:1821001405
Name:JOHNSON COUNTY HOSPITAL
Entity Type:Organization
Organization Name:JOHNSON COUNTY HOSPITAL
Other - Org Name:JOHNSON COUNTY HOSPITAL HOME HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:KENT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-335-3361
Mailing Address - Street 1:PO BOX 599
Mailing Address - Street 2:
Mailing Address - City:TECUMSEH
Mailing Address - State:NE
Mailing Address - Zip Code:68450-0599
Mailing Address - Country:US
Mailing Address - Phone:404-335-3371
Mailing Address - Fax:402-335-3447
Practice Address - Street 1:202 HIGH ST
Practice Address - Street 2:
Practice Address - City:TECUMSEH
Practice Address - State:NE
Practice Address - Zip Code:68450-2443
Practice Address - Country:US
Practice Address - Phone:402-335-3361
Practice Address - Fax:402-335-6342
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOHNSON COUNTY HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-14
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE451001251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE00419OtherBCBS OF NEBRASKA
NE=========01Medicaid
NE=========01Medicaid