Healthcare Provider Details

I. General information

NPI: 1851006209
Provider Name (Legal Business Name): SRMC LONG TERM CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2023
Last Update Date: 01/19/2023
Certification Date: 01/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

549 KELLER DR
SIDNEY NE
69162-1775
US

IV. Provider business mailing address

1000 POLE CREEK XING
SIDNEY NE
69162-2901
US

V. Phone/Fax

Practice location:
  • Phone: 308-254-5825
  • Fax:
Mailing address:
  • Phone: 308-254-5825
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number
License Number State

VIII. Authorized Official

Name: KELLY UTLEY
Title or Position: CFO
Credential:
Phone: 308-254-5825