MEDICARE: CHRISTIAN 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	ALF030	NE
2	314000000X	Skilled Nursing Facility	614002	NE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	28D0652676	OTHER	NE	CLIA NUMBER
2	614002	OTHER	NE	NEBRASKA SKILLED LICENSE
3	ALF030	OTHER	NE	NE ASSISTED LIV. LICENSE

General Provider Information

NPI Number	:	1912901505
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHRISTIAN HOMES, INC.

Provider Business Mailing Address
First Line	:	1923 W 4TH AVE
Second Line	:
City	:	HOLDREGE
State	:	NE
Zip	:	68949-3113
Country	:	US
Telephone Number	:	308-995-4493
Fax Number	:	308-995-8702

Provider Business Practice Location Address
First Line	:	1923 WEST 4TH AVENUE
Second Line	:
City	:	HOLDREGE
State	:	NE
Zip	:	68949-3113
Country	:	US
Telephone Number	:	308-995-4493
Fax Number	:	308-995-8702

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. DONALD W. BAKKE
Credential	:	NURSING HOME ADMIN.
Telephone Number	:	308-995-4493

Provider Enumeration Date	:	06/10/2005
Last Update Date	:	10/28/2013

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