Healthcare Provider Details

I. General information

NPI: 1003807942
Provider Name (Legal Business Name): MID-NEBRASKA LUTHERAN HOME, ASSN.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 12/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 N 2ND ST
NEWMAN GROVE NE
68758-6017
US

IV. Provider business mailing address

PO BOX 459 109 NORTH 2ND STREET
NEWMAN GROVE NE
68758-0459
US

V. Phone/Fax

Practice location:
  • Phone: 402-447-6203
  • Fax: 402-447-6363
Mailing address:
  • Phone: 402-447-6203
  • Fax: 402-447-6244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number524003
License Number StateNE

VIII. Authorized Official

Name: MRS. LINDSI LUEKEN
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 402-447-6203