Provider Demographics
NPI:1285724229
Name:ELMS HEALTH CARE CENTER INC
Entity type:Organization
Organization Name:ELMS HEALTH CARE CENTER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:R
Authorized Official - Last Name:HATCHER
Authorized Official - Suffix:
Authorized Official - Credentials:ADMINISTRATOR
Authorized Official - Phone:402-755-2233
Mailing Address - Street 1:6857 W JUANA DR
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-6662
Mailing Address - Country:US
Mailing Address - Phone:602-920-2056
Mailing Address - Fax:
Practice Address - Street 1:410 BALL PARK RD
Practice Address - Street 2:
Practice Address - City:PONCA
Practice Address - State:NE
Practice Address - Zip Code:68770-7243
Practice Address - Country:US
Practice Address - Phone:402-755-2233
Practice Address - Fax:402-755-2245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE244001314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========00Medicaid
NE285191Medicare Oscar/Certification
NE=========00Medicaid