Provider Demographics
NPI:1184915977
Name:WEL-LIFE AT SCOTTSBLUFF
Entity type:Organization
Organization Name:WEL-LIFE AT SCOTTSBLUFF
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-642-7736
Mailing Address - Street 1:617 WEST 33RD ST
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBLUFF
Mailing Address - State:NE
Mailing Address - Zip Code:69361-4590
Mailing Address - Country:US
Mailing Address - Phone:308-632-1760
Mailing Address - Fax:308-632-1782
Practice Address - Street 1:617 W 33RD ST
Practice Address - Street 2:
Practice Address - City:SCOTTSBLUFF
Practice Address - State:NE
Practice Address - Zip Code:69361-4590
Practice Address - Country:US
Practice Address - Phone:308-632-1760
Practice Address - Fax:308-632-1782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-27
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility