=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558641787
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GOLDEN LIVING CENTER-NELIGH
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/19/2011
-----------------------------------------------------
Last Update Date | 08/19/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16 COTTONWOOD DR BOX 37
-----------------------------------------------------
City | NIOBRARA
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68760-6083
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-649-2065
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16 COTTONWOOD DRIVE P O BOX 37
-----------------------------------------------------
City | NIOBRARA
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68760
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-649-2065
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MPT
-----------------------------------------------------
Name | MS. NATALIE MOODY WRAGGE
-----------------------------------------------------
Credential | PT
-----------------------------------------------------
Telephone | 402-649-2065
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number | 1723
-----------------------------------------------------
License Number State | NE
-----------------------------------------------------