Provider Demographics
NPI:1972975290
Name:SPENCER SENIOR LIVING, INC.
Entity type:Organization
Organization Name:SPENCER SENIOR LIVING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JOANN
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN BUREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-589-0025
Mailing Address - Street 1:406 W VINTON ST
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:NE
Mailing Address - Zip Code:68777-3638
Mailing Address - Country:US
Mailing Address - Phone:402-589-0025
Mailing Address - Fax:402-589-0026
Practice Address - Street 1:406 WEST VINTON ST.
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:NE
Practice Address - Zip Code:68777-0241
Practice Address - Country:US
Practice Address - Phone:402-589-0025
Practice Address - Fax:402-589-0026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-26
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEALF082310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility