Healthcare Provider Details

I. General information

NPI: 1962435180
Provider Name (Legal Business Name): PARK VIEW HAVEN NURSING HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 12/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 NORTH MADISON
COLERIDGE NE
68727-2602
US

IV. Provider business mailing address

309 NORTH MADISON
COLERIDGE NE
68727-2602
US

V. Phone/Fax

Practice location:
  • Phone: 402-283-4224
  • Fax:
Mailing address:
  • Phone: 402-283-4224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number124001
License Number StateNE

VIII. Authorized Official

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