MEDICARE: ST. JOSEPHS VILLA INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	094002	NE

General Provider Information

NPI Number	:	1104823046
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST. JOSEPHS VILLA INC

Provider Business Mailing Address
First Line	:	927 N 7TH ST
Second Line	:
City	:	DAVID CITY
State	:	NE
Zip	:	68632
Country	:	US
Telephone Number	:	402-367-3045
Fax Number	:	402-367-3730

Provider Business Practice Location Address
First Line	:	927 N 7TH ST
Second Line	:
City	:	DAVID CITY
State	:	NE
Zip	:	68632
Country	:	US
Telephone Number	:	402-367-3045
Fax Number	:	402-367-3730

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	SANDRA K PALMER
Credential	:
Telephone Number	:	402-367-3045

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	11/09/2016

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Directions to “ST. JOSEPHS VILLA INC ” Practice Location

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