MEDICARE: CITY OF MITCHELL

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	310400000X	Assisted Living Facility	ALF266	NE
2	314000000X	Skilled Nursing Facility	704003	NE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689712952
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY OF MITCHELL

Provider Business Mailing Address
First Line	:	1723 23RD ST
Second Line	:
City	:	MITCHELL
State	:	NE
Zip	:	69357-1000
Country	:	US
Telephone Number	:	308-623-1212
Fax Number	:	308-623-2052

Provider Business Practice Location Address
First Line	:	1723 23RD ST
Second Line	:
City	:	MITCHELL
State	:	NE
Zip	:	69357
Country	:	US
Telephone Number	:	308-623-1212
Fax Number	:	308-623-2052

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. STEPHANIE JUNE HAHN
Credential	:
Telephone Number	:	308-623-1212

Provider Enumeration Date	:	02/01/2007
Last Update Date	:	07/25/2018

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Directions to “CITY OF MITCHELL ” Practice Location

Language	Start Address	Practice Location

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