Provider Demographics
NPI:1336382530
Name:ALEGENT HEALTH BERGAN MERCY HEALTH SYSTEM
Entity Type:Organization
Organization Name:ALEGENT HEALTH BERGAN MERCY HEALTH SYSTEM
Other - Org Name:ALEGENT HEALTH AT HOME - CORNING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:EVERT
Authorized Official - Middle Name:
Authorized Official - Last Name:KUIPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-343-4420
Mailing Address - Street 1:801 N 96TH ST STE 201
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-2592
Mailing Address - Country:US
Mailing Address - Phone:402-898-8000
Mailing Address - Fax:402-898-8080
Practice Address - Street 1:703 ROSARY DR
Practice Address - Street 2:
Practice Address - City:CORNING
Practice Address - State:IA
Practice Address - Zip Code:50841-1685
Practice Address - Country:US
Practice Address - Phone:641-322-6283
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALEGENT HEALTH BERGAN MERCY HEALTH SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-04-17
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
167319Medicare Oscar/Certification