Provider Demographics
NPI:1134196058
Name:DOUGLAS COUNTY NEBRASKA
Entity type:Organization
Organization Name:DOUGLAS COUNTY NEBRASKA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-444-7041
Mailing Address - Street 1:4102 WOOLWORTH AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68105-1899
Mailing Address - Country:US
Mailing Address - Phone:402-444-6091
Mailing Address - Fax:402-444-7369
Practice Address - Street 1:4102 WOOLWORTH AVE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68105-1899
Practice Address - Country:US
Practice Address - Phone:402-444-6091
Practice Address - Fax:402-444-7369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-01
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE264024314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE000241OtherBC/BS SKILLED NURSING
NE=========-10Medicaid
NE000241OtherBC/BS SKILLED NURSING
NE=========-05Medicaid
NE=========-07Medicaid
NE=========-12Medicaid
NECE1593Medicare ID - Type UnspecifiedRAILROAD PART B
NE=========-10Medicaid
NE096581Medicare ID - Type UnspecifiedPART B