Healthcare Provider Details

I. General information

NPI: 1083602692
Provider Name (Legal Business Name): GORDON MEMORIAL HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 E 10TH ST
GORDON NE
69343-1157
US

IV. Provider business mailing address

500 E 10TH ST
GORDON NE
69343-1157
US

V. Phone/Fax

Practice location:
  • Phone: 308-282-0806
  • Fax: 308-282-0251
Mailing address:
  • Phone: 308-282-0806
  • Fax: 308-282-0251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number14
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberALF070
License Number StateNE
# 3
Primary TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number734001
License Number StateNE

VIII. Authorized Official

Name: MRS. KRISSA L RUCKER
Title or Position: ADMINISTRATOR
Credential: R.N.
Phone: 308-282-0806