Healthcare Provider Details

I. General information

NPI: 1861487696
Provider Name (Legal Business Name): PLAINVIEW MANOR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2005
Last Update Date: 03/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 W HARPER AVE
PLAINVIEW NE
68769-2037
US

IV. Provider business mailing address

101 W HARPER AVE
PLAINVIEW NE
68769-2037
US

V. Phone/Fax

Practice location:
  • Phone: 402-582-3849
  • Fax: 402-582-3850
Mailing address:
  • Phone: 402-582-3849
  • Fax: 402-582-3850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number624002
License Number StateNE

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier28E136
Identifier TypeOTHER
Identifier StateNE
Identifier IssuerHHS FEDERAL
# 2
Identifier28E136
Identifier TypeMEDICAID
Identifier StateNE
Identifier Issuer

VIII. Authorized Official

Name: MRS. JULEEN MARIE JOHNSON
Title or Position: ADMINISTRATOR
Credential:
Phone: 402-582-3849