Healthcare Provider Details

I. General information

NPI: 1982979894
Provider Name (Legal Business Name): CITY OF GENOA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2012
Last Update Date: 03/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

706 EWING ST
GENOA NE
68640-3035
US

IV. Provider business mailing address

PO BOX 310
GENOA NE
68640-0310
US

V. Phone/Fax

Practice location:
  • Phone: 402-993-2283
  • Fax: 402-993-2373
Mailing address:
  • Phone: 402-993-2283
  • Fax: 402-993-2373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code315D00000X
TaxonomyInpatient Hospice
License NumberHOSPICE 48
License Number StateNE

VIII. Authorized Official

Name: AMANDA ROEBUCK
Title or Position: HOSPICE ADMINISTRATOR
Credential: RN
Phone: 402-993-2283