MEDICARE: CITY OF HAY SPRINGS PIONEER MANOR NURSING HOME

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
2	314000000X	Skilled Nursing Facility	734002	NE

General Provider Information

NPI Number	:	1699756742
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY OF HAY SPRINGS PIONEER MANOR NURSING HOME

Provider Business Mailing Address
First Line	:	PO BOX 310
Second Line	:
City	:	HAY SPRINGS
State	:	NE
Zip	:	69347-0310
Country	:	US
Telephone Number	:	308-638-4483
Fax Number	:	308-638-7385

Provider Business Practice Location Address
First Line	:	318 N 3RD
Second Line	:
City	:	HAY SPRINGS
State	:	NE
Zip	:	69347-0310
Country	:	US
Telephone Number	:	308-638-4483
Fax Number	:	308-638-7385

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MS. PATSY A BRIDGE
Credential	:	N.H.A.
Telephone Number	:	308-638-4483

Provider Enumeration Date	:	11/07/2005
Last Update Date	:	08/07/2008

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