Healthcare Provider Details

I. General information

NPI: 1073577680
Provider Name (Legal Business Name): MOUNT CARMEL HOME KEENS MEMORIAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2006
Last Update Date: 06/24/2022
Certification Date: 06/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 W 18TH ST
KEARNEY NE
68845-5948
US

IV. Provider business mailing address

412 W 18TH ST
KEARNEY NE
68845-5948
US

V. Phone/Fax

Practice location:
  • Phone: 308-237-2287
  • Fax: 308-237-7264
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number074003
License Number StateNE

VIII. Authorized Official

Name: TRACY BANDA
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 308-237-2287