Provider Demographics
NPI:1932107711
Name:KISMET CDR, LLC
Entity Type:Organization
Organization Name:KISMET CDR, LLC
Other - Org Name:CREST VIEW HEALTHCARE COMMUNITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-642-7736
Mailing Address - Street 1:420 GORDON AVE
Mailing Address - Street 2:
Mailing Address - City:CHADRON
Mailing Address - State:NE
Mailing Address - Zip Code:69337-2006
Mailing Address - Country:US
Mailing Address - Phone:308-432-3355
Mailing Address - Fax:
Practice Address - Street 1:420 GORDON AVE
Practice Address - Street 2:
Practice Address - City:CHADRON
Practice Address - State:NE
Practice Address - Zip Code:69337-2006
Practice Address - Country:US
Practice Address - Phone:308-432-3355
Practice Address - Fax:308-432-4335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-14
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE214001314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026749400Medicaid
NE285150Medicare Oscar/Certification