MEDICARE: HERITAGE OF WAUNETA, 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
1	314000000X	Skilled Nursing Facility	134002	NE

General Provider Information

NPI Number	:	1972612778
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HERITAGE OF WAUNETA, INC

Provider Business Mailing Address
First Line	:	PO BOX 520
Second Line	:
City	:	WAUNETA
State	:	NE
Zip	:	69045-0520
Country	:	US
Telephone Number	:	308-394-5738
Fax Number	:	308-394-5733

Provider Business Practice Location Address
First Line	:	427 W LEGION
Second Line	:
City	:	WAUNETA
State	:	NE
Zip	:	69045-4549
Country	:	US
Telephone Number	:	308-394-5738
Fax Number	:	308-394-5733

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	:	07/23/2012

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