=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962435180
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PARK VIEW HAVEN NURSING HOME
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/09/2006
-----------------------------------------------------
Last Update Date | 12/08/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 309 NORTH MADISON
-----------------------------------------------------
City | COLERIDGE
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68727-2602
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-283-4224
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 309 NORTH MADISON
-----------------------------------------------------
City | COLERIDGE
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68727-2602
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-283-4224
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | SHERYL I KALIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 402-283-4224
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number | 124001
-----------------------------------------------------
License Number State | NE
-----------------------------------------------------