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General NPI Number Information
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NPI Number | 1073577680
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Entity Type | Organization
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Legal Business Name | MOUNT CARMEL HOME KEENS MEMORIAL
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Dates
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Enumeration Date | 04/12/2006
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Last Update Date | 06/24/2022
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Provider Practice Location Address
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Address Line | 412 W 18TH ST
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City | KEARNEY
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State | NE
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Zip | 68845-5948
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Country | US
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Telephone | 308-237-2287
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Fax | 308-237-7264
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Provider Business Mailing Address
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Address Line | 412 W 18TH ST
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City | KEARNEY
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State | NE
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Zip | 68845-5948
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | TRACY BANDA
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Credential |
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Telephone | 308-237-2287
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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 | 074003
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License Number State | NE
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