Provider Demographics
NPI:1962578997
Name:PENDER CARE CENTRE DISTRICT INC
Entity type:Organization
Organization Name:PENDER CARE CENTRE DISTRICT INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:J
Authorized Official - Last Name:GAMBLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-385-3083
Mailing Address - Street 1:200 VALLEY VIEW DR
Mailing Address - Street 2:
Mailing Address - City:PENDER
Mailing Address - State:NE
Mailing Address - Zip Code:68047-4443
Mailing Address - Country:US
Mailing Address - Phone:402-385-3072
Mailing Address - Fax:402-385-2603
Practice Address - Street 1:200 VALLEY VIEW DR
Practice Address - Street 2:
Practice Address - City:PENDER
Practice Address - State:NE
Practice Address - Zip Code:68047-4443
Practice Address - Country:US
Practice Address - Phone:402-385-3072
Practice Address - Fax:402-385-2603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE42116496400314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10024972000Medicaid
NE285186Medicare Oscar/Certification