Provider Demographics
NPI:1851673800
Name:THE MARY LANNING MEMORIAL HOSPITAL A
Entity Type:Organization
Organization Name:THE MARY LANNING MEMORIAL HOSPITAL A
Other - Org Name:MARY LANNING HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:NEET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-461-5108
Mailing Address - Street 1:715 NORTH ST. JOSEPH AVENUE
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901-4451
Mailing Address - Country:US
Mailing Address - Phone:402-460-5868
Mailing Address - Fax:402-461-5091
Practice Address - Street 1:148 BROAD STREET
Practice Address - Street 2:GRANDVIEW MANOR
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:402-756-8705
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE MARY LANNING MEMORIAL HOSPITAL ASSOCIATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE11251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025114000Medicaid