Healthcare Provider Details

I. General information

NPI: 1003924929
Provider Name (Legal Business Name): GRAND ISLAND HEALTH CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 07/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3119 W FAIDLEY AVE
GRAND ISLAND NE
68803-4114
US

IV. Provider business mailing address

3119 W FAIDLEY AVE
GRAND ISLAND NE
68803-4114
US

V. Phone/Fax

Practice location:
  • Phone: 308-384-2333
  • Fax: 308-384-3620
Mailing address:
  • Phone: 308-384-2333
  • Fax: 308-384-3620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number374006
License Number StateNE

VIII. Authorized Official

Name: JACK DEAN VETTER
Title or Position: PRESIDENT
Credential:
Phone: 402-895-3932