Healthcare Provider Details

I. General information

NPI: 1962578997
Provider Name (Legal Business Name): PENDER CARE CENTRE DISTRICT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 10/17/2022
Certification Date: 10/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 VALLEY VIEW DR
PENDER NE
68047-4443
US

IV. Provider business mailing address

200 VALLEY VIEW DR
PENDER NE
68047-4443
US

V. Phone/Fax

Practice location:
  • Phone: 402-385-3072
  • Fax: 402-385-2603
Mailing address:
  • Phone: 402-385-3072
  • Fax: 402-385-2603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number42116496400
License Number StateNE

VIII. Authorized Official

Name: LAURA J GAMBLE
Title or Position: CEO
Credential:
Phone: 402-385-3083