Provider Demographics
NPI:1255449252
Name:HERITAGE OF EMERSON INC
Entity type:Organization
Organization Name:HERITAGE OF EMERSON INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:VETTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-895-3932
Mailing Address - Street 1:607 NEBRASKA ST
Mailing Address - Street 2:
Mailing Address - City:EMERSON
Mailing Address - State:NE
Mailing Address - Zip Code:68733-3627
Mailing Address - Country:US
Mailing Address - Phone:402-695-2683
Mailing Address - Fax:402-695-2188
Practice Address - Street 1:607 NEBRASKA ST
Practice Address - Street 2:
Practice Address - City:EMERSON
Practice Address - State:NE
Practice Address - Zip Code:68733-3627
Practice Address - Country:US
Practice Address - Phone:402-695-2683
Practice Address - Fax:402-695-2188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE204001314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47061452900Medicaid
NE285222Medicare Oscar/Certification
NE388770001Medicare NSC
NE28D0719178Medicare ID - Type UnspecifiedMEDICARE CLIA WAIVER