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NPI Code Detail

MEDICARE: MILDER MANOR, INC

MEDICARE: MILDER MANOR, 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 Facility504008NE

General Provider Information

NPI Number : 1902914518
Entity Type Code : Organization
Provider Name (Legal Business Name) : MILDER MANOR, INC
Provider Business Mailing Address
First Line : 1750 S 20TH ST
Second Line :
City : LINCOLN
State : NE
Zip : 68502-2611
Country : US
Telephone Number : 402-475-6791
Fax Number : 402-475-3792
Provider Business Practice Location Address
First Line : 1750 S 20TH ST
Second Line :
City : LINCOLN
State : NE
Zip : 68502-2611
Country : US
Telephone Number : 402-475-6791
Fax Number : 402-475-3792
Authorized Official
Title or Position : PRESIDENT
Name : JACK DEAN VETTER
Credential :
Telephone Number : 402-895-3932
Provider Enumeration Date : 08/25/2006
Last Update Date : 05/28/2013

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Directions to “MILDER MANOR, INC ” Practice Location

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