Provider Demographics
NPI:1912980921
Name:LOUISVILLE CARE CENTER
Entity Type:Organization
Organization Name:LOUISVILLE CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KARI
Authorized Official - Middle Name:
Authorized Official - Last Name:WOCKENFUSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-234-2125
Mailing Address - Street 1:410 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:NE
Mailing Address - Zip Code:68037-6006
Mailing Address - Country:US
Mailing Address - Phone:402-234-2125
Mailing Address - Fax:402-234-2431
Practice Address - Street 1:410 W 5TH ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:NE
Practice Address - Zip Code:68037-6006
Practice Address - Country:US
Practice Address - Phone:402-234-2125
Practice Address - Fax:402-234-2431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-23
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE114001314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE28E096Medicaid
NE28E096Medicaid
NE0145760001Medicare NSC