Provider Demographics
NPI:1295760361
Name:CITY OF STANTON NURSING HOME
Entity type:Organization
Organization Name:CITY OF STANTON NURSING HOME
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTS RECEIVABLE
Authorized Official - Prefix:
Authorized Official - First Name:BETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:PETERSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-439-2111
Mailing Address - Street 1:PO BOX 407
Mailing Address - Street 2:
Mailing Address - City:STANTON
Mailing Address - State:NE
Mailing Address - Zip Code:68779-0407
Mailing Address - Country:US
Mailing Address - Phone:402-439-2111
Mailing Address - Fax:402-439-2132
Practice Address - Street 1:301 17TH ST
Practice Address - Street 2:
Practice Address - City:STANTON
Practice Address - State:NE
Practice Address - Zip Code:68779-0407
Practice Address - Country:US
Practice Address - Phone:402-439-2111
Practice Address - Fax:402-439-2132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEALF193310400000X
314000000X, 310400000X
NE754001314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========00Medicaid
NE=========00Medicaid