Healthcare Provider Details

I. General information

NPI: 1508419789
Provider Name (Legal Business Name): SPRING CREEK HOME, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2019
Last Update Date: 07/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 MICHIGAN AVE
INAVALE NE
68952-8000
US

IV. Provider business mailing address

602 MICHIGAN AVE
INAVALE NE
68952-8000
US

V. Phone/Fax

Practice location:
  • Phone: 402-746-3267
  • Fax:
Mailing address:
  • Phone: 402-746-3267
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: CASEY JO SNELL
Title or Position: ADMINISTRATOR
Credential:
Phone: 402-746-3267