Healthcare Provider Details

I. General information

NPI: 1912980921
Provider Name (Legal Business Name): LOUISVILLE CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2005
Last Update Date: 10/30/2012
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

410 W 5TH ST
LOUISVILLE NE
68037-6006
US

V. Phone/Fax

Practice location:
  • Phone: 402-234-2125
  • Fax: 402-234-2431
Mailing address:
  • Phone: 402-234-2125
  • Fax: 402-234-2431

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number114001
License Number StateNE

VIII. Authorized Official

Name: MRS. KARI WOCKENFUSS
Title or Position: ADMINISTRATOR
Credential:
Phone: 402-234-2125