Provider Demographics
NPI:1831153295
Name:MID AMERICA CARE CENTERS, INC.
Entity type:Organization
Organization Name:MID AMERICA CARE CENTERS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:VICKY
Authorized Official - Middle Name:A
Authorized Official - Last Name:GOC
Authorized Official - Suffix:
Authorized Official - Credentials:ADMINISTRATOR
Authorized Official - Phone:402-489-7175
Mailing Address - Street 1:6101 NORMAL BLVD
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-2767
Mailing Address - Country:US
Mailing Address - Phone:402-489-7175
Mailing Address - Fax:402-489-5270
Practice Address - Street 1:6101 NORMAL BLVD
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-2767
Practice Address - Country:US
Practice Address - Phone:402-489-7175
Practice Address - Fax:402-489-5270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-13
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE504005314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========11Medicaid
NE=========11Medicaid
NE0215280001Medicare NSC