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General NPI Number Information
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NPI Number | 1043291453
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Entity Type | Organization
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Legal Business Name | MOTHER HULL HOME
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Dates
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Enumeration Date | 11/11/2005
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Last Update Date | 10/14/2016
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Provider Practice Location Address
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Address Line | 125 E 23RD STREET
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City | KEARNEY
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State | NE
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Zip | 68847-5425
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Country | US
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Telephone | 308-234-2447
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Fax | 308-234-6823
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Provider Business Mailing Address
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Address Line | 125 E 23RD STREET
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City | KEARNEY
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State | NE
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Zip | 68847-5425
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Country | US
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Telephone | 308-234-2447
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Fax | 308-234-6823
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. STEPHANIE SIMMONS
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Credential |
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Telephone | 308-234-2447
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 074002
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License Number State | NE
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