Healthcare Provider Details

I. General information

NPI: 1124012208
Provider Name (Legal Business Name): K C HEALTH CARE ENTERPRISES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2005
Last Update Date: 03/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2520 AVENUE M
GOTHENBURG NE
69138-2527
US

IV. Provider business mailing address

2520 AVENUE M
GOTHENBURG NE
69138-2527
US

V. Phone/Fax

Practice location:
  • Phone: 308-537-7138
  • Fax: 308-537-7130
Mailing address:
  • Phone: 308-537-7138
  • Fax: 308-537-7130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number224002
License Number StateNE

VIII. Authorized Official

Name: MR. SCOTT BAHE
Title or Position: ADMINISTRATOR
Credential:
Phone: 308-537-7138