Healthcare Provider Details

I. General information

NPI: 1033229547
Provider Name (Legal Business Name): HERITAGE OF DAVID CITY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 05/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 S 10TH ST
DAVID CITY NE
68632-2032
US

IV. Provider business mailing address

260 S 10TH ST
DAVID CITY NE
68632-2032
US

V. Phone/Fax

Practice location:
  • Phone: 402-367-3144
  • Fax: 402-367-4246
Mailing address:
  • Phone: 402-367-3144
  • Fax: 402-367-4246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number94001
License Number StateNE

VIII. Authorized Official

Name: JACK DEAN VETTER
Title or Position: PRESIDENT
Credential:
Phone: 402-895-3932