Provider Demographics
NPI:1952828352
Name:CLARKSON COMMUNITY CARE CENTER INC.
Entity Type:Organization
Organization Name:CLARKSON COMMUNITY CARE CENTER INC.
Other - Org Name:CLARKSON COMMUNITY CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:EAGLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-892-3494
Mailing Address - Street 1:212 SUNRISE DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSON
Mailing Address - State:NE
Mailing Address - Zip Code:68629-4042
Mailing Address - Country:US
Mailing Address - Phone:402-892-3494
Mailing Address - Fax:
Practice Address - Street 1:212 SUNRISE DR
Practice Address - Street 2:
Practice Address - City:CLARKSON
Practice Address - State:NE
Practice Address - Zip Code:68629-4042
Practice Address - Country:US
Practice Address - Phone:402-892-3494
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE174001225X00000X, 235Z00000X, 261QP2000X, 310400000X, 314000000X
314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Multi-Specialty
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026893500Medicaid
NENH0040OtherDHHS