Healthcare Provider Details

I. General information

NPI: 1104823046
Provider Name (Legal Business Name): ST. JOSEPHS VILLA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 11/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

927 N 7TH ST
DAVID CITY NE
68632
US

IV. Provider business mailing address

927 N 7TH ST
DAVID CITY NE
68632
US

V. Phone/Fax

Practice location:
  • Phone: 402-367-3045
  • Fax: 402-367-3730
Mailing address:
  • Phone: 402-367-3045
  • Fax: 402-367-3730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number094002
License Number StateNE

VIII. Authorized Official

Name: SANDRA K PALMER
Title or Position: ADMINISTRATOR
Credential:
Phone: 402-367-3045