Provider Demographics
NPI:1972591808
Name:BLUE VALLEY LUTHERAN HOMES SOCIETY INC
Entity Type:Organization
Organization Name:BLUE VALLEY LUTHERAN HOMES SOCIETY INC
Other - Org Name:BLUE VALLEY LUTHERAN NURSING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUG
Authorized Official - Middle Name:A
Authorized Official - Last Name:CHOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-768-3900
Mailing Address - Street 1:P.O. BOX 166
Mailing Address - Street 2:P. O. BOX 166
Mailing Address - City:HEBRON
Mailing Address - State:NE
Mailing Address - Zip Code:68370-2008
Mailing Address - Country:US
Mailing Address - Phone:402-768-3900
Mailing Address - Fax:402-768-3901
Practice Address - Street 1:220 PARK AVENUE
Practice Address - Street 2:
Practice Address - City:HEBRON
Practice Address - State:NE
Practice Address - Zip Code:68370-2008
Practice Address - Country:US
Practice Address - Phone:402-768-3900
Practice Address - Fax:402-768-3901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-13
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE764002314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE285259Medicare Oscar/Certification
NE0411180001Medicare NSC