Provider Demographics
NPI:1255412532
Name:TRENTON NURSING HOME - VILLAGE OF TRENTON
Entity type:Organization
Organization Name:TRENTON NURSING HOME - VILLAGE OF TRENTON
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VILLAGE OF TRENTON MAYOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:RUNDEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-334-5214
Mailing Address - Street 1:PO BOX 97
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:NE
Mailing Address - Zip Code:69044-0097
Mailing Address - Country:US
Mailing Address - Phone:308-334-5241
Mailing Address - Fax:308-334-5243
Practice Address - Street 1:71434 HIGHWAY 25
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NE
Practice Address - Zip Code:69044-1714
Practice Address - Country:US
Practice Address - Phone:308-334-5241
Practice Address - Fax:308-334-5243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2012-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE404001314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========Medicaid
NE=========Medicaid