Provider Demographics
NPI:1811881980
Name:BADGLEY, SHANAE MARIE
Entity type:Individual
Prefix:
First Name:SHANAE
Middle Name:MARIE
Last Name:BADGLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 HIGHWAY 61 S
Mailing Address - Street 2:
Mailing Address - City:OGALLALA
Mailing Address - State:NE
Mailing Address - Zip Code:69153-4157
Mailing Address - Country:US
Mailing Address - Phone:308-231-0156
Mailing Address - Fax:
Practice Address - Street 1:175 HIGHWAY 61 S
Practice Address - Street 2:
Practice Address - City:OGALLALA
Practice Address - State:NE
Practice Address - Zip Code:69153-4157
Practice Address - Country:US
Practice Address - Phone:308-231-0156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-04
Last Update Date:2025-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home