Healthcare Provider Details

I. General information

NPI: 1134412992
Provider Name (Legal Business Name): FAIRBURY ASSISTED LIVING FACILITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2011
Last Update Date: 05/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

828 22ND ST
FAIRBURY NE
68352-1202
US

IV. Provider business mailing address

828 22ND ST
FAIRBURY NE
68352-1202
US

V. Phone/Fax

Practice location:
  • Phone: 402-729-3351
  • Fax: 402-729-2102
Mailing address:
  • Phone: 402-729-3351
  • Fax: 402-729-2102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberALF281
License Number StateNE

VIII. Authorized Official

Name: MR. CHAD JURGENS
Title or Position: SECRETARY
Credential:
Phone: 402-729-3351