MEDICARE: AMERICAN BAPTIST HOMES OF THE MIDWEST

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	264009	NE

General Provider Information

NPI Number	:	1073501896
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMERICAN BAPTIST HOMES OF THE MIDWEST

Provider Business Mailing Address
First Line	:	2824 NORTH 66TH AVE
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68104-3928
Country	:	US
Telephone Number	:	402-551-8282
Fax Number	:	402-551-1819

Provider Business Practice Location Address
First Line	:	2824 NORTH 66TH AVE
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68104-3928
Country	:	US
Telephone Number	:	402-551-8282
Fax Number	:	402-551-1819

Authorized Official
Title or Position	:	DIRECTOR OF RESIDNET RECEIVABLES
Name	:	CHRISTINA R KOTZ
Credential	:
Telephone Number	:	402-551-2110

Provider Enumeration Date	:	10/06/2005
Last Update Date	:	08/03/2022

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