Provider Demographics
NPI:1124323126
Name:HAVELOCK MANOR.
Entity type:Organization
Organization Name:HAVELOCK MANOR.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JANINE
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:STEARNS
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:402-464-2222
Mailing Address - Street 1:6330 PLATTE AVE
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68507-1349
Mailing Address - Country:US
Mailing Address - Phone:402-464-2222
Mailing Address - Fax:402-464-2225
Practice Address - Street 1:6330 PLATTE AVE
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68507-1349
Practice Address - Country:US
Practice Address - Phone:402-464-2222
Practice Address - Fax:402-464-2225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-21
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEALF 335310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE100258547-00Medicaid