Healthcare Provider Details

I. General information

NPI: 1689712952
Provider Name (Legal Business Name): CITY OF MITCHELL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 07/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1723 23RD ST
MITCHELL NE
69357
US

IV. Provider business mailing address

1723 23RD ST
MITCHELL NE
69357-1000
US

V. Phone/Fax

Practice location:
  • Phone: 308-623-1212
  • Fax: 308-623-2052
Mailing address:
  • Phone: 308-623-1212
  • Fax: 308-623-2052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberALF266
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number704003
License Number StateNE

VIII. Authorized Official

Name: MRS. STEPHANIE JUNE HAHN
Title or Position: ADMINISTRATOR
Credential:
Phone: 308-623-1212