Healthcare Provider Details

I. General information

NPI: 1669550844
Provider Name (Legal Business Name): ALEGENT HEALTH IMMANUEL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 02/10/2022
Certification Date: 02/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6901 N 72ND ST ATTN ADMINISTRATOR
OMAHA NE
68122-1709
US

IV. Provider business mailing address

6901 N 72ND ST ATTN ADMINISTRATOR
OMAHA NE
68122-1709
US

V. Phone/Fax

Practice location:
  • Phone: 402-572-2970
  • Fax:
Mailing address:
  • Phone: 402-572-2970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number264600
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: EVERT KUIPER
Title or Position: CEO - CHI HEALTH
Credential:
Phone: 402-343-4420