MEDICARE: HOLDREGE MEMORIAL HOMES, 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	310400000X	Assisted Living Facility	ALF110	NE
2	314000000X	Skilled Nursing Facility	614003	NE

General Provider Information

NPI Number	:	1235132184
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOLDREGE MEMORIAL HOMES, INC.

Provider Business Mailing Address
First Line	:	1320 11TH AVE
Second Line	:
City	:	HOLDREGE
State	:	NE
Zip	:	68949-1919
Country	:	US
Telephone Number	:	308-995-8631
Fax Number	:	308-995-8636

Provider Business Practice Location Address
First Line	:	1320 11TH AVE
Second Line	:
City	:	HOLDREGE
State	:	NE
Zip	:	68949-1919
Country	:	US
Telephone Number	:	308-995-8631
Fax Number	:	308-995-8636

Authorized Official
Title or Position	:	DIRECTOR/ADMINISTRATOR
Name	:	KEVIN MORIARTY
Credential	:
Telephone Number	:	308-995-8631

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	01/12/2022

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