Healthcare Provider Details

I. General information

NPI: 1871602607
Provider Name (Legal Business Name): HERITAGE OF RED CLOUD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

636 N LOCUST ST
RED CLOUD NE
68970-2463
US

IV. Provider business mailing address

636 N LOCUST ST
RED CLOUD NE
68970-2463
US

V. Phone/Fax

Practice location:
  • Phone: 402-746-2296
  • Fax: 402-746-2325
Mailing address:
  • Phone: 402-746-2296
  • Fax: 402-746-2325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number814002
License Number StateNE

VIII. Authorized Official

Name: JACK DEAN VETTER
Title or Position: PRESIDENT
Credential:
Phone: 402-895-3932