Basic Information
Provider Information | |||||||||
NPI: | 1770509515 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | SAINT ELIZABETH REGIONAL MEDICAL CENTER | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | SAINT ELIZABETH HOME HEALTH CARE | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 555 S 70TH ST | ||||||||
Address2: |   | ||||||||
City: | LINCOLN | ||||||||
State: | NE | ||||||||
PostalCode: | 685102462 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4022197721 | ||||||||
FaxNumber: | 4022198973 | ||||||||
Practice Location | |||||||||
Address1: | 245 S 84TH ST | ||||||||
Address2: | SUITE 111 | ||||||||
City: | LINCOLN | ||||||||
State: | NE | ||||||||
PostalCode: | 685102680 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4022197043 | ||||||||
FaxNumber: | 4022197800 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/14/2006 | ||||||||
LastUpdateDate: | 08/22/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | WOJTALEWICZ | ||||||||
AuthorizedOfficialFirstName: | JEANETTE | ||||||||
AuthorizedOfficialMiddleName: | M | ||||||||
AuthorizedOfficialTitleorPosition: | VICE PRESIDENT FINANCE AND CFO | ||||||||
AuthorizedOfficialTelephone: | 4022197721 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | MS. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | 501005 | NE | Y |   | Agencies | Home Health |   |
No ID Information.