Healthcare Provider Details

I. General information

NPI: 1699682161
Provider Name (Legal Business Name): ELAINE'S TAVERN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 MAIN AVE
WINNETOON NE
68789-7013
US

IV. Provider business mailing address

305 MAIN AVE
WINNETOON NE
68789-7013
US

V. Phone/Fax

Practice location:
  • Phone: 402-847-3321
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number State

VIII. Authorized Official

Name: BARBARA BOGGS
Title or Position: OWNER
Credential:
Phone: 402-360-0751