Healthcare Provider Details

I. General information

NPI: 1124314901
Provider Name (Legal Business Name): VILLAGE OF COLERIDGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2011
Last Update Date: 06/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 W CEDAR ST
COLERIDGE NE
68727-2622
US

IV. Provider business mailing address

509 W CEDAR ST
COLERIDGE NE
68727-2622
US

V. Phone/Fax

Practice location:
  • Phone: 402-283-5020
  • Fax: 402-283-4236
Mailing address:
  • Phone: 402-283-5020
  • Fax: 402-283-4236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberALF223
License Number StateNE

VIII. Authorized Official

Name: MRS. SHERYL I. KALIN
Title or Position: ADMINISTRATOR
Credential:
Phone: 402-283-4224