Healthcare Provider Details

I. General information

NPI: 1104815778
Provider Name (Legal Business Name): CRETE AREA MECICAL CENTER LTC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1540 GROVE AVE
CRETE NE
68333-1749
US

IV. Provider business mailing address

1540 GROVE AVE PO BOX 220
CRETE NE
68333-1749
US

V. Phone/Fax

Practice location:
  • Phone: 402-826-6867
  • Fax: 402-826-6827
Mailing address:
  • Phone: 402-826-6867
  • Fax: 402-826-6827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License NumberLTCH009
License Number StateNE

VIII. Authorized Official

Name: MS. CAROL KOHLES
Title or Position: DON/ASST. ADM
Credential: RN
Phone: 402-826-6805