Healthcare Provider Details

I. General information

NPI: 1952828352
Provider Name (Legal Business Name): CLARKSON COMMUNITY CARE CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2017
Last Update Date: 07/21/2022
Certification Date: 02/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 SUNRISE DR
CLARKSON NE
68629-4042
US

IV. Provider business mailing address

212 SUNRISE DR
CLARKSON NE
68629-4042
US

V. Phone/Fax

Practice location:
  • Phone: 402-892-3494
  • Fax:
Mailing address:
  • Phone: 402-892-3494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number174001
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number174001
License Number StateNE
# 3
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number174001
License Number StateNE
# 4
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number174001
License Number StateNE
# 5
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number174001
License Number StateNE
# 6
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: HEATHER EAGLE
Title or Position: ADMINISTRATOR
Credential:
Phone: 402-892-3494