Healthcare Provider Details

I. General information

NPI: 1346364536
Provider Name (Legal Business Name): LOUISVILLE CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 W 5TH ST
LOUISVILLE NE
68037-6006
US

IV. Provider business mailing address

6915 WRIGHT PLZ APT # L8
OMAHA NE
68106-3400
US

V. Phone/Fax

Practice location:
  • Phone: 402-234-2125
  • Fax:
Mailing address:
  • Phone: 308-379-9328
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1255
License Number StateNE

VIII. Authorized Official

Name: MS. MEGAN MARIE COATES
Title or Position: OCCUPATIONAL THERAPIST
Credential: OTR
Phone: 308-379-9328