Provider Demographics
NPI:1902860190
Name:CITY OF CRAWFORD
Entity Type:Organization
Organization Name:CITY OF CRAWFORD
Other - Org Name:PONDEROSA VILLA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:J
Authorized Official - Last Name:PERKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-665-1224
Mailing Address - Street 1:PO BOX 526
Mailing Address - Street 2:1ST & PADDOCK
Mailing Address - City:CRAWFORD
Mailing Address - State:NE
Mailing Address - Zip Code:69339
Mailing Address - Country:US
Mailing Address - Phone:308-665-1224
Mailing Address - Fax:308-665-2450
Practice Address - Street 1:1ST & PADDOCK
Practice Address - Street 2:
Practice Address - City:CRAWFORD
Practice Address - State:NE
Practice Address - Zip Code:69339
Practice Address - Country:US
Practice Address - Phone:308-665-1224
Practice Address - Fax:308-665-2450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-14
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE214002314000000X
314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE060034OtherBLUE CROSS BLUE SHIELD
NE=========-00Medicaid
NE060034OtherBLUE CROSS BLUE SHIELD
NE=========00Medicaid
NE=========-00Medicaid