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NPI Code Detail

MEDICARE: HERITAGE OF ST PAUL, INC

MEDICARE: HERITAGE OF ST PAUL, INC
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
1314000000XSkilled Nursing Facility434001NE

General Provider Information

NPI Number : 1457460230
Entity Type Code : Organization
Provider Name (Legal Business Name) : HERITAGE OF ST PAUL, INC
Provider Business Mailing Address
First Line : 1405 HERITAGE DR
Second Line :
City : SAINT PAUL
State : NE
Zip : 68873-3618
Country : US
Telephone Number : 308-754-5486
Fax Number : 308-754-5385
Provider Business Practice Location Address
First Line : 1405 HERITAGE DR
Second Line :
City : SAINT PAUL
State : NE
Zip : 68873-3618
Country : US
Telephone Number : 308-754-5486
Fax Number : 308-754-5385
Authorized Official
Title or Position : PRESIDENT
Name : JACK DEAN VETTER
Credential :
Telephone Number : 402-895-3932
Provider Enumeration Date : 08/29/2006
Last Update Date : 07/17/2013

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Directions to “HERITAGE OF ST PAUL, INC ” Practice Location

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