Healthcare Provider Details

I. General information

NPI: 1104108141
Provider Name (Legal Business Name): THE MARY LANNING MEMORIAL HOSPITAL ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2011
Last Update Date: 03/26/2020
Certification Date: 03/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1710 IDAHO STREET GOOD SAMARITAN SOCIETY - SUPERIOR
SUPERIOR NE
68978-9574
US

IV. Provider business mailing address

715 NORTH ST. JOSEPH AVENUE
HASTINGS NE
68901-4451
US

V. Phone/Fax

Practice location:
  • Phone: 402-879-4791
  • Fax: 402-879-3149
Mailing address:
  • Phone: 402-460-5868
  • Fax: 402-461-5091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number11
License Number StateNE

VIII. Authorized Official

Name: ERIC A BARBER
Title or Position: PRESIDENT/CEO
Credential:
Phone: 402-463-4521