Provider Demographics
NPI:1912034620
Name:SUTTON COMMUNITY HOME, INC
Entity Type:Organization
Organization Name:SUTTON COMMUNITY HOME, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:HANNAH
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:ELLIOTT
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, MA, NHA
Authorized Official - Phone:402-773-5557
Mailing Address - Street 1:1106 NORTH SAUNDERS AVE
Mailing Address - Street 2:
Mailing Address - City:SUTTON
Mailing Address - State:NE
Mailing Address - Zip Code:68979-2406
Mailing Address - Country:US
Mailing Address - Phone:402-773-5557
Mailing Address - Fax:402-773-5559
Practice Address - Street 1:1106 NORTH SAUNDERS AVE
Practice Address - Street 2:
Practice Address - City:SUTTON
Practice Address - State:NE
Practice Address - Zip Code:68979-2406
Practice Address - Country:US
Practice Address - Phone:402-773-5557
Practice Address - Fax:402-773-5559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEALF235310400000X
NE164003313M00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========Medicaid
NE=========Medicaid
28E156Medicare UPIN