Provider Demographics
NPI:1063403053
Name:COMMUNITY MEMORIAL HOSPITAL, INC.
Entity type:Organization
Organization Name:COMMUNITY MEMORIAL HOSPITAL, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGEMENT/BOM
Authorized Official - Prefix:
Authorized Official - First Name:HAYLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:GROSHANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-346-4440
Mailing Address - Street 1:PO BOX 340
Mailing Address - Street 2:295 N 8TH
Mailing Address - City:BURWELL
Mailing Address - State:NE
Mailing Address - Zip Code:68823-0340
Mailing Address - Country:US
Mailing Address - Phone:308-346-4440
Mailing Address - Fax:308-346-5184
Practice Address - Street 1:1015 F ST
Practice Address - Street 2:
Practice Address - City:BURWELL
Practice Address - State:NE
Practice Address - Zip Code:68823-5440
Practice Address - Country:US
Practice Address - Phone:308-346-4440
Practice Address - Fax:308-346-5184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-31
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NELTCH005314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
285257Medicare Oscar/Certification
NE28-5257Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER